Impact of Anxiety on Health-Related Quality of Life and Symptoms of Burnout in Multi-Professional Residents in Brazil During the COVID-19 Pandemic.

We aimed to determine the prevalence of anxiety and to identify associated factors among multi-professional residents in Brazil during the early days of the COVID-19 pandemic. A cross-sectional study included a sample of 752 multi-professional residents selected by snowball technique. Symptoms of anxiety were measured by the Beck anxiety inventory scale (≥ 16 cut-off). We used WHOQOL-BREF to access the health-related quality of life and the Maslach Burnout Inventory to measure the burnout syndrome. PR and respective 95% confidence intervals (CI) were calculated using the Poisson regression model. The prevalence of anxiety was 41.2% (310/752). Some variables were strongly associated with anxiety: afraid of getting COVID-19; extra work demand during COVID-19 pandemic; sweating/wheezing/increased heart rate during work; feeling safe when using personal protective equipment at work, and psychological support from residence preceptors. Residents with symptoms of anxiety showed high emotional exhaustion at work (36.6 ± 9.6 vs. 24.7 ± 10.7, P = 0.001) and depersonalization (8.9 ± 6.0 vs. 5.6 ± 4.9, P = 0.001). Correlations coefficients between emotional exhaustion versus Physical WHOQOL-BREF and between emotional exhaustion versus Psychological WHOQOL-BREF were significantly lower among residents without anxiety (P = 0.027 and P = 0,03, respectively). The prevalence of anxiety was high and strongly associated with several variables, particularly with being afraid of getting COVID-19, the perception of workload, somatization (sweating, wheezing and increased heart rate during work), feeling unsafe when using personal protective equipment, and lack of psychological support from residence preceptors. Anxiety was associated with increased emotional exhaustion and depersonalization and low health-related quality of life during the COVID-19 pandemic in Brazil. Low WHOQOL-BREF environment domain, and high emotional exhaustion MBI domain increased the chances of presenting symptoms of anxiety.

Validation of the brazilian version of the Penn State College of Medicine Professionalism Questionnaire / Validação da versão brasileira do Questionário de Profissionalismo da Penn State College of Medicine

Abstract Introduction: Assessing professionalism represents a challenge for medical educators given the nature of its construct, which comprises diverse values, beliefs, and principles. Understanding this psychological phenomenon is fundamental for reaching the goals in medical education. Objective: This study aimed to translate into Brazilian Portuguese and to validate the Penn State College of Medicine Professionalism Questionnaire. Method: The questionnaire was translated, and cross-culturally adapted into Brazilian Portuguese using data from 249 medical students. An exploratory factor analysis was conducted, using a polychoric matrix and the Robust Diagonally Weighted Least Squares method of extraction. The following model adequacy indexes and criteria were used: Root Mean Square Error of Approximation (RMSEA) adjustment indexes <0.08, Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) >0.90. Result: The exploratory factor analysis obtained a KMO = 0.920, and a significant Bartlett's test of sphericity (2719.0, gl = 630; P <0.001). The parallel analysis yielded a three-factor solution, which showed adequate levels of reliability: Professional-Patient Relationship, Professional Development and Ethical Commitment. The three-factor solution was the best one found to represent the data. Conclusion: The questionnaire evidenced good psychometric properties and appropriateness to evaluate medical students' professionalism, contributing to reach more desirable ethical standards in medical education.

Resumo Introdução: Avaliar o profissionalismo representa um desafio para os educadores médicos dada a natureza de seu construto que compreende diversos valores, crenças e princípios. A compreensão desse fenômeno psicológico é fundamental para o alcance dos objetivos da educação médica. Objetivo: Este estudo teve como objetivos traduzir para o português brasileiro e validar o Questionário de Profissionalismo da Penn State College of Medicine. Método: O questionário foi traduzido e adaptado transculturalmente para o português brasileiro com dados de 249 estudantes de Medicina. Na condução da análise fatorial exploratória, utilizaram-se uma matriz policórica e o método de extração Robust Diagonally Weighted Least Squares. Os seguintes índices e critérios de adequação do modelo foram usados: índices de ajuste da raiz quadrada da média do erro de aproximação (RMSEA) < 0,08, índice de ajuste comparativo (CFI) e índice de Tucker-Lewis (TLI) > 0,90. Resultado: A análise fatorial exploratória obteve um KMO = 0,920 e um teste de esfericidade de Bartlett significativo (2719,0, gl = 630; P < 0,001). A análise paralela resultou em uma solução de três fatores que apresentou níveis adequados de confiabilidade: relacionamento profissional-paciente, desenvolvimento profissional e compromisso ético. A solução de três fatores foi considerada a melhor para representar os dados. Conclusão: O questionário evidenciou boas propriedades psicométricas e adequação para avaliar o profissionalismo dos estudantes de Medicina, contribuindo para o alcance de padrões éticos mais desejáveis na educação médica.

Validation of the RAND 36-Item Health Survey questionnaire in Brazil.

BACKGROUND: Health-related quality of life is frequently used as an outcome measure that improves the quality of care. The SF-36 and RAND-36 were derived from the Medical Outcomes Study. OBJECTIVE: The present study aimed to validate the RAND-36 in Brazil, in healthy individuals and patients with liver disease. METHODS: Confirmatory factor analysis (CFA) was conducted by using JASP Software. The parameters of the items were estimated using the Robust Diagonally Weighted Least Squares (RDWLS) approach. Comparative fit index (CFI), Goodness-of-fit index (GFI), Tucker-Lewis Index (TLI) and the root mean square error of approximation (RMSEA) were evaluated. Internal consistency was measured using the Composite reliability index. Convergent validity between RAND-36 domains and Work Ability Index (WAI) was conducted. RESULTS: This validation study included 763 individuals, 400 (52.4%) with chronic liver disease. The most prevalent liver diseases were hepatitis C (13.9%), alcoholic liver disease (11.8%), and steatosis (12.1%). The measurement model tested using the CFA obtained the following adjustment indicators: X2 (df): 599.65 (498); CFI: 0.998; GFI: 0.998; TLI: 0.998; RMSEA: 0.016 (90%CI: 0.011-.021). Convergent validity of RAND-36 and total WAI ranged from medium to large correlation. CONCLUSION: The RAND-36 is effective in measuring the perception of health-related quality of life in individuals with and without chronic liver disease. The results of our study support the developer's claims for the reliability of the RAND-36 version 1 as a measure of health-related quality of life. The evidence for the construct validity of the RAND-36 was substantial.

Validation of the RAND 36-Item Health Survey questionnaire in Brazil / Validação do questionário RAND 36-Item Health Survey no Brasil

ABSTRACT Background: Health-related quality of life is frequently used as an outcome measure that improves the quality of care. The SF-36 and RAND-36 were derived from the Medical Outcomes Study. Objective The present study aimed to validate the RAND-36 in Brazil, in healthy individuals and patients with liver disease. Methods: Confirmatory factor analysis (CFA) was conducted by using JASP Software. The parameters of the items were estimated using the Robust Diagonally Weighted Least Squares (RDWLS) approach. Comparative fit index (CFI), Goodness-of-fit index (GFI), Tucker-Lewis Index (TLI) and the root mean square error of approximation (RMSEA) were evaluated. Internal consistency was measured using the Composite reliability index. Convergent validity between RAND-36 domains and Work Ability Index (WAI) was conducted. Results: This validation study included 763 individuals, 400 (52.4%) with chronic liver disease. The most prevalent liver diseases were hepatitis C (13.9%), alcoholic liver disease (11.8%), and steatosis (12.1%). The measurement model tested using the CFA obtained the following adjustment indicators: X2 (df): 599.65 (498); CFI: 0.998; GFI: 0.998; TLI: 0.998; RMSEA: 0.016 (90%CI: 0.011-.021). Convergent validity of RAND-36 and total WAI ranged from medium to large correlation. Conclusion: The RAND-36 is effective in measuring the perception of health-related quality of life in individuals with and without chronic liver disease. The results of our study support the developer's claims for the reliability of the RAND-36 version 1 as a measure of health-related quality of life. The evidence for the construct validity of the RAND-36 was substantial.

RESUMO Contexto: A qualidade de vida relacionada à saúde é frequentemente usada como uma medida de resultado que melhora a qualidade da atenção à saúde. O SF-36 e o RAND-36 foram derivados do Medical Outcomes Study. Objetivo O presente estudo teve como objetivo validar o RAND-36 no Brasil, em indivíduos saudáveis e pacientes com doença hepática. Métodos: A análise fatorial confirmatória (AFC) foi realizada usando o software JASP. Os parâmetros do elemento foram estimados usando o método Robust Diagonally Weighted Least Squares (RDWLS). O índice de ajuste comparativo (CFI), o índice de adequação (GFI), o índice de Tucker-Lewis (TLI) e o erro quadrático médio de aproximação (RMSEA) foram avaliados. A consistência interna foi medida pelo índice de confiabilidade composta. A validade convergente foi realizada entre os domínios do RAND-36 e o Índice de Capacidade para o Trabalho (ICT). Resultados : Este estudo de validação incluiu 763 indivíduos, 400 (52,4%) com doença hepática crônica. As doenças hepáticas mais prevalentes foram hepatite C (13,9%), doença alcoólica do fígado (11,8%) e esteatose (12,1%). O modelo de medida testado com a AFC obteve os seguintes indicadores de ajuste: X2 (gl): 599,65 (498); CFI: 0,998; GFI: 0,998; TLI: 0,998; RMSEA: 0,016 (90%CI: 0,011-0,021). A validade convergente do RAND-36 e do ICT total variou de média a grande correlação. Conclusão: O RAND-36 é eficaz para medir a percepção da qualidade de vida relacionada à saúde em indivíduos com e sem doença hepática crônica. Os resultados do nosso estudo apoiam as afirmações dos desenvolvedores sobre a confiabilidade do RAND-36 versão 1 como uma medida de qualidade de vida relacionada à saúde. A evidência para a validade do construto do RAND-36 foi substancial.

Anxiety, health-related quality of life, and symptoms of burnout in frontline physicians during the COVID-19 pandemic.

BACKGROUND: COVID-19 pandemic caused increased workload and stress for health professionals involved in the care of such patients. We aimed to describe the health-related quality of life, and burnout in frontline physicians diagnosed with anxiety during the COVID-19 pandemic. METHODS: This was a cross-sectional study conducted during the first-wave phase of COVID-19, from September to October 2020. Questionnaires were sent electronically to 450 physicians from State of Bahia, assessing symptoms of anxiety, health-related quality of life (HRQOL) and burnout syndrome. For the categorical variables, the Pearson's chi-square test was used and difference between means was compare using the Mann-Whitney test. was Groups with and without anxiety symptoms were compared using prevalence ratios (PR). Pearson's correlation measured the correlation between WHOQOL-BREF and MBI (Maslach Burnout Inventory) domains. The Fisher r-to-z transformation was used to assess the significance of the difference between two correlation coefficients. The significance level was <0.05. RESULTS: Out of the 450 physicians, 223 (49,6%) completely answered the questionnaire and 38 (17%) showed symptoms of anxiety. Physicians with anxiety had higher scores in emotional exhaustion (EE) (38.31 ± 8.59 vs 25.31±0.87; p = 0.0001) and depersonalization (DP) (9.0 ± 5.6 vs 5.9 ± 5.3; p = 0.001) domains, and lower scores in personal accomplishment (PA) (32.1 ± 8.2 vs 36.3 ± 7.6; p = 0.004), than those without anxiety. All correlations between WHOQOL-BREF domains and MBI in physicians without anxiety were significant (p = 0.01). CONCLUSION: Physicians with anxiety showed more emotional exhaustion, less personal accomplishment, and lower quality of life. All domains of WHOQOL BREF were correlated with all MBI domains among physicians without anxiety. Differences in correlation according to anxiety were remarkable in psychological HOQOL BREF domain and emotional exhaustion and depersonalization MBI domains. The effect of anxiety leading to poorer levels of perceived health needs to be further investigated.

Anxiety, health-related quality of life, and symptoms of burnout in frontline physicians during the COVID-19 pandemic

ABSTRACT Background: COVID-19 pandemic caused increased workload and stress for health professionals involved in the care of such patients. We aimed to describe the health-related quality of life, and burnout in frontline physicians diagnosed with anxiety during the COVID-19 pandemic. Methods: This was a cross-sectional study conducted during the first-wave phase of COVID19, from September to October 2020. Questionnaires were sent electronically to 450 physicians from State of Bahia, assessing symptoms of anxiety, health-related quality of life (HRQOL) and burnout syndrome. For the categorical variables, the Pearson's chi-square test was used and difference between means was compare using the Mann-Whitney test. was Groups with and without anxiety symptoms were compared using prevalence ratios (PR). Pearson's correlation measured the correlation between WHOQOL-BREF and MBI (Maslach Burnout Inventory) domains. The Fisher r-to-z transformation was used to assess the significance of the difference between two correlation coefficients. The significance level was <0.05. Results: Out of the 450 physicians, 223 (49,6%) completely answered the questionnaire and 38 (17%) showed symptoms of anxiety. Physicians with anxiety had higher scores in emotional exhaustion (EE) (38.31 ± 8.59 vs 25.31±0.87; p = 0.0001) and depersonalization (DP) (9.0 ± 5.6 vs 5.9 ± 5.3; p = 0.001) domains, and lower scores in personal accomplishment (PA) (32.1 ± 8.2 vs 36.3 ± 7.6; p = 0.004), than those without anxiety. All correlations between WHOQOL-BREF domains and MBI in physicians without anxiety were significant (p = 0.01). Conclusion: Physicians with anxiety showed more emotional exhaustion, less personal accomplishment, and lower quality of life. All domains of WHOQOL BREF were correlated with all MBI domains among physicians without anxiety. Differences in correlation according to anxiety were remarkable in psychological HOQOL BREF domain and emotional exhaustion and depersonalization MBI domains. The effect of anxiety leading to poorer levels of perceived health needs to be further investigated.

Implementation of the Choosing Wisely Campaign at a Medical Clinic Internship / Implementação da Campanha Choosing Wisely no Internato de Clínica Médica

Abstract: Objective: to evaluate the implementation of the Choosing Wisely (CW) campaign strategies at a medical clinic internship. Methods: This interventional study involved internship teachers and students, using online questionnaires on the SurveyMonkey platform, and face-to-face activities. Using the Delphi technique, teachers identified three unnecessary situations that commonly occur in practice. The recommendations were grouped by frequency and subject, adapted to the CW format. A Likert scale was used to classify the specialists' opinion aiming to obtain the final list of recommendations. Before the introduction of the CW campaign, we conducted an Objective Structured Clinical Examination (OSCE). Two groups of students were compared: one group that underwent the same OSCE evaluation before the implementation of the CW campaign (110), and another group that participated of all educational actions (n = 98). The CW campaign was implemented by developing educational actions using the recommendations during workshops, banners, and theoretical evaluation, in addition to an Objective Structured Clinical Examination (OSCE). Results: after grouping the recommendations, 24 items remained. The specialists selected eight recommendations by frequency, addressing unnecessary behaviors such as requesting multiple exams, overuse of non-hormonal anti-inflammatory drugs, the indication of digestive endoscopy in younger patients with dyspepsia, excessive chest X-rays in intensive care unit, prescribing antibiotic prophylaxis for longer than recommended, routine indication of allergic tests, inadequate initial screening for thyroid assessment, and spirometry in asymptomatic patients. The educational actions resulted in a process of awareness and discussion among the participants, evidenced by theoretical evaluation (> 95%), as well as in the OSCE, where the level of successes was higher in the exposed group when compared to the nonexposed group (p = 0.001). Conclusion: the implementation of the CW campaign improved the clinical skills of medical clinic internship students and allowed positive discussions about cost-consciousness in health.

Resumo: Objetivo: avaliar a implementação de estratégias da campanha Choosing Wisely (CW) no internato de clínica médica. Métodos: Este estudo de intervenção envolveu professores e alunos do internato, por meio de questionários on-line na plataforma SurveyMonkey e atividades presenciais. Usando a técnica Delphi, os professores identificaram três situações desnecessárias que geralmente ocorrem na prática. As recomendações foram agrupadas por frequência e assunto e adaptadas ao formato CW. Utilizou-se uma escala Likert para classificar a opinião dos especialistas, obtendo-se a lista final de recomendações. Antes da introdução da campanha da CW, realizamos um Exame Clínico Objetivo Estruturado (OSCE). Foram comparados dois grupos de estudantes: um grupo que realizou a avaliação OSCE antes da implantação da campanha CW (110) e outro que participou de todas as ações educativas (n = 98). Implementamos a campanha da CW, desenvolvendo ações educativas usando as recomendações durante oficinas, banners e avaliação teórica, além de um Exame Clínico Objetivo Estruturado (OSCE). Resultados: após o agrupamento das recomendações, restaram 24 itens. Os especialistas selecionaram oito recomendações, abordando comportamentos desnecessários como solicitação de vários exames, uso excessivo de anti-inflamatórios não hormonais, indicação de endoscopia digestiva para pacientes mais jovens com dispepsia, excesso de radiografia de tórax em unidade de terapia intensiva, prescrição de profilaxia antibiótica por mais tempo do que o recomendado, indicação de rotina de testes alérgicos, triagem inicial inadequada para avaliação da tireóide e espirometria em pacientes assintomáticos. As ações educativas resultaram em conscientização e discussão entre os participantes, evidenciado por meio de avaliação teórica (> 95%), bem como no OSCE, onde o nível de sucessos foi maior no grupo exposto quando comparado ao grupo não exposto (p = 0,001). Conclusão: a implementação da campanha CW melhorou as habilidades clínicas dos estudantes do internato em clínica médica e permitiu discussões positivas sobre custo-consciência em saúde.

Validity and reliability of the 36-Item Short Form Health Survey questionnaire version 2 among people living with HIV in Brazil.

BACKGROUND: The 36-Item Short Form Health Survey questionnaire (SF-36) is a widely used instrument for evaluating health-related quality-of-life (HRQoL). The psychometric validation of the SF-36 version 2.0 (SF-36v2) in HIV-infected patients had not yet conducted in Brazil. AIM: To test data quality, reliability and validity of the SF-36v2 as a measure of HRQoL among Brazilian individuals living with HIV. METHODS: A cross-sectional study included 393 HIV-infected patients in whom HRQoL was assessed by using the SF-36v2 questionnaire. Demographic characteristics, socioeconomic status and clinical data were also collected. The SF-36 version 1 translated into Brazilian-Portuguese was adapted and introduced version 2 improvements according to the instrument developers. SPSS version 21 was used for data analyses. Confirmatory factor analysis (CFA) and structural equation modelling were performed using AMOS SPSS version 18. T-test for independent samples was used to compare differences between mean levels of HRQoL components in different groups. Linear multiple regression techniques were used to analyze the relationship between Physical Component Summary (PCS), Mental Component Summary (MCS) and independent variables. RESULTS: We performed the CFA and tested the hypothetical measurement model. We included five parameters to improve the adherence of data to the model. All indicators met the requirement suggested by specialized literature (χ2 (gl): 980.7 (527); CFI: 0.949; GFI: 0.873; TLI: 0.943; RMSEA: 0.047; 90% IC: 0.042-0.051). Multiple regression analyses revealed that depression (p=0.001), family income (p=0.007), sex (p=0.001) and age (p<0.021) were associated with MCS. Comorbidities (p=0.001), health self-perception (p=0.001), age (p=0.001), and sex (p=0.025) were associated with PCS. CONCLUSIONS: A consistent validation of the SF-36v2 in Brazilian HIV patients were shown. Further studies with SF-36v2 psychometric analyses would be required in other populations to establish Brazilian normative data.

Choosing Wisely in Pediatric Internship.

Background. The Choosing Wisely (CW) campaign informs physicians and the public about safety and quality in medical practice. Objective. To evaluate a CW campaign in a medical internship in pediatrics. Methods. An interventionist study with teachers of medicine and pediatric internship students in which the Delphi technique was applied using online questionnaires. Specialists identified 3 unnecessary situations that commonly occur in clinical practice. Following the Objective Structured Clinical Examination (OSCE) model evaluation, a group of students who participated in the educational interventions was compared with another group that was not exposed to the campaign. Results. Most students evaluated the CW campaign content as excellent (64%) or very good (31.6%). The level of successes in the OSCE evaluation was higher in the exposed group when compared with the nonexposed group (P = .001). Conclusions. The CW campaign improved the clinical skills of pediatric internship students.

Translation, transcultural adaptation, and validation of the role-modeling cost-conscious behaviors scale.

BACKGROUND: Training in the use of cost-conscious strategies for medical students may prepare new physicians to deliver health care in a more sustainable way. Recently, a role-modeling cost-conscious behaviors scale (RMCCBS) was developed for assessing students' perceptions of their teachers' attitudes to cost consciousness. We aimed to translate the RMCCBS into Brazilian Portuguese, adapt the scale, transculturally, and validate it. METHODS: We adopted rigorous methodological approaches for translating, transculturally adapting and validating the original scale English version into Brazilian Portuguese. We invited all 400 undergraduate medical students enrolled in the 5th and 6th years of a medical course in Northeast Brazil between January and March 2017 to participate. Of the 400 students, 281 accepted to take part in the study. We analyzed the collected data using the SPSS software version 21 and structural equation modeling (SEM) was performed using AMOS SPSS version 18. We conducted exploratory factor analysis (EFA), varimax rotation, with Kaiser Normalization and Principal Axis Factoring extraction method. We conducted confirmatory factor analysis (CFA), using the SEM. We used the following indexes of adherence of the model: Comparative fit index (CFI), Goodness-of-fit index (GFI) and Tucker-Lewis Index (TLI). We considered the Bayesian Information Criterion (BIC) for Sample-size adjusted. The root mean square error of approximation was calculated. Values below 0.08 were considered acceptable. Composite reliability analyzes were performed to evaluate the accuracy of the instrument. Values above 0.70 were considered satisfactory. RESULTS: Of the 281 undergraduate medical students, 195 (69.3%) were female. Mean age of participants was 25.0 ± 2.6 years. In the EFA, the KMO was 0.720 and the Bartlett sphericity test was significant (p < 0.001). We conducted the EFA into two factors: role-modeling cost-conscious behaviors in health (seven items) and health waste behaviors (six items). The 13 item-scale was submitted to composite reliability analyzes, obtaining values of 0.813 and 0.761 for the role-modeling cost-conscious behaviors and the health waste behaviors factors, respectively. CONCLUSIONS: We concluded that the cost-conscious behaviors scale has good psychometric properties and is a valid and reliable instrument for evaluating medical students' perception of their teachers' cost-conscious behaviors.

Uso de documentário no curso de medicina e a reflexão sobre temas éticos associados ao aborto / The use of documentary in medical course and a reflection on ethical issues associated with abortion / Uso de documental en la carrera de medicina y reflexión sobre temas éticos asociados al aborto

Resumo O ensino das humanidades na graduação de medicina, principalmente da ética e bioética, é imprescindível para o sucesso da futura relação médico-paciente. A arte cinematográfica vem se destacando como instrumento eficaz de ensino-aprendizagem, pois prepara o aluno para refletir e lidar com diversos conflitos da prática médica. Trata-se de estudo descritivo, com método qualitativo e emprego da técnica de análise temática a partir do documentário "À margem do corpo" como recurso didático para identificar as principais temáticas éticas abordadas pelos alunos e seus posicionamentos em relação a elas. Participaram deste estudo 50 alunos do segundo período de curso de medicina. Quatro temáticas principais foram discutidas: vulnerabilidade e redução da autonomia; objeção de consciência; desumanização e negligência na assistência à saúde; e aborto.

Abstract The teaching of the humanities in medical education, especially ethics and bioethics, is essential for the future doctor-patient relationship. The use of cinematographic art as a teaching-learning instrument has emerged as an effective and contributory method in this process, as it makes the student more reflective and prepared to deal with the various conflicts of medical practice. This is a descriptive study, with uses a qualitative methodology, applying the thematic analysis technique that aimed to evaluate the use of the film "À Margem do Corpo" as a teaching-learning instrument of medical ethics and also to identify the main ethical issues faced by the students and their positions in front of them. A group of 50 students from the second period of the medical course participated in the study. Four main themes were discussed: vulnerability and reduced autonomy; objection of conscience; dehumanization and neglect in health care; abortion.

Resumen La enseñanza de las humanidades en la carrera de grado de medicina, principalmente de la ética y la bioética, es imprescindible para la futura relación médico-paciente. La utilización del arte cinematográfico como instrumento de enseñanza-aprendizaje viene destacándose como un método eficaz y contributivo en este proceso, pues torna al alumno más reflexivo y preparado para lidiar con los diversos conflictos de la práctica médica. Se trata de un estudio descriptivo, con metodología cualitativa, aplicando la técnica de análisis temático que tuvo como objetivo evaluar la utilización de la película "Al Margen del Cuerpo" como instrumento de enseñanza-aprendizaje de la ética médica e identificar las principales temáticas éticas abordadas por los alumnos y sus posicionamientos frente a éstas. Participó de este estudio un grupo-clase del segundo período de la carrera de medicina compuesta por 50 alumnos. Se discutieron cuatro temáticas principales: vulnerabilidad y reducción de la autonomía; objeción de conciencia; deshumanización y negligencia en la asistencia sanitaria; y aborto.

"As intermitências da morte" no ensino da ética e bioética / "Death With Interruptions" in the teaching of Ethics and Bioethics / "Las intermitencias de la muerte" en la enseñanza de la Ética y Bioética

Resumo As diretrizes curriculares para o curso de graduação em medicina preconizam formação médica humanista, reflexiva e ética. Determinam também que o profissional médico esteja apto para acompanhar o processo de morte, sendo fundamental para isso a avaliação de métodos ativos de ensino-aprendizagem das humanidades e da ética e bioética no curso de medicina. Este artigo propõe avaliar o uso da obra "As intermitências da morte" de José Saramago como ferramenta de ensino da ética e bioética, abordando essencialmente reflexões individuais e coletivas ao lidar com o tema da morte. Trata-se de estudo descritivo com análise qualitativa de avaliação da obra em questão por alunos de medicina da Escola Bahiana de Medicina e Saúde Pública. Conclui-se que esse instrumento é recomendado no ensino das humanidades, comprovando que sua leitura atribuiu capacidades subjetivas ao estudante para lidar com situações relacionadas à morte respeitando os princípios da bioética.

Abstract The curriculum guidelines for undergraduate medical courses recommend that medical training should be humanistic, reflective, and ethical. Furthermore, medical professionals should be able to provide support in the process of death, with the evaluation of active methodologies for the teaching and learning of humanities, ethics, and bioethics a fundamental part of medical courses. The present study evaluates the use of the novel "Death with interruptions" as a teaching tool for ethics and bioethics, addressing individual and collective reflections when dealing with the theme of death. This is a descriptive study with a qualitative approach, analyzing the evaluation of a literary work by medical students from the Escola Bahiana de Medicina e Saúde Pública (the Bahia School of Medicine and Public Health). The study concluded that this instrument is recommended for the teaching of humanities, finding that its reading encouraged the development of subjective abilities in students to deal with situations related to death, respecting the principles of bioethics.

Resumen Las directrices del plan de estudios de la Licenciatura en Medicina abogan por una formación médico-humanista, reflexiva y ética. También determina que el profesional de medicina es capaz de acompañar el proceso de la muerte, siendo fundamental la importancia de la evaluación de métodos activos de enseñanza en las humanidades, la ética y la bioética en la carrera de medicina. El estudio tiene como objetivo evaluar el uso de la obra literaria "Las intermitencias de la muerte" como herramienta de enseñanza de la Ética y Bioética, de las reflexiones para enfrentar el tema de la muerte. Se trata de un estudio descriptivo, con análisis cualitativo de la evaluación por parte de los estudiantes de medicina de una obra literaria. El estudio reveló la recomendación de este instrumento en la enseñanza de las humanidades, lo que demuestra que la lectura asigna capacidades subjetivas de los estudiantes para enfrentar situaciones relacionadas con la muerte.

MULHERES CARDIOPATAS ESTÃO RECEBENDO ORIENTAÇÕES DE PLANEJAMENTO FAMILIAR DE FORMA SISTEMÁTICA? / ARE WOMEN WITH CARDIAC DISEASE RECEIVING FAMILY PLANNING ORIENTATIONS IN A SYSTEMATIC WAY? / ¿MUJERES CARDIOPATAS ESTÁN RECIBIENDO ORIENTACIONES DE PLANIFICACIÓN FAMILIAR DE FORMA SISTEMÁTICA?

A condução de mulheres cardiopata em fase reprodutiva traz dilemas de escolhas frente à expectativa de gestações futuras. O planejamento familiar no acompanhamento dessas pacientes visa à redução da morbimortalidade materno-fetal. O objetivo deste estudo foi identificar orientações de planejamento familiar e condutas contraceptivas em pacientes submetidas a cirurgia para troca valvar, além de descrever o perfil da valvopatia e tipo de prótese. Para tanto, fez-se um estudo transversal, retrospectivo e descritivo, realizado em um centro público da Bahia no período de 2009 a 2013. A amostra foi constituída de pacientes em idade fértil (15-49 anos) submetidas acirurgia de troca valvar. Revistos os prontuários de 70 pacientes, a média de idade foi 33,67±8,037 anos. Os resultados indicaram que o acometimento univalvar ocorreu em 42 casos (60%), tendo como diagnóstico predominante Insuficiência Mitral isolada, com 19 (45,24%) casos. Quanto ao tipo de prótese utilizada, 61 (87,1%) pacientes receberam a biológica enquanto nove (12,9%) a metálica. Observou-se que 64 (91,4%) pacientes apresentaram histórico de cardiopatia reumática. Não houve registro de orientação de planejamento familiar. Concluiu-se que pacientes submetidas a cirurgia para troca valvar não recebiam orientações sobre planejamento familiar ou histórico gestacional; havia um comprometimento predominante univalvar e por insuficiência mitral, assim como uso preferencial de próteses biológicas.

The follow up of childbearing age women with cardiac disease carries choices' dilemmas related to the expectation of future pregnancies. Family planning for those patients aims reducing maternal-fetal morbimortality. The objective of this study was to identify family planning orientations and contraceptive measures in patients subjected to heart valve replacement surgery, besides describing the valvulopathy profile and the kind of prosthesis. Therefore, this cross-sectional, retrospective and descriptive study was made by using medical records from a public center in the period between 2009 and 2013. The sample consists of childbearing age patients (15-49 years old) who underwent heart valve replacement. We reviewed 70 charts and the mean age was 33,67 ±8,037 years old. Univalvular injury occurred in 42 (60%) patients, mitral insufficiency is the most predominant diagnostic, 19 (45,24%) cases. Regarding the type of prosthesis, 61 (87,1%) received bioprosthesis while nine (12,9%) received metallic one. A history of rheumatic fever was identified for 64 (91,4%) patients. There was no record related to family planning orientations or contraceptive measures. In conclusion, the there is a lack of family planning orientations or gestational history records in the charts for the patients who underwent heart valve replacement, there is predominantly univalvular injury due to mitral insufficiency, besides the preferential choice for bioprosthesis.

La conducción de mujeres cardiópata en fase reproductiva trae dilemas de elecciones frente a la expectativa de futuras gestaciones. Planificación familiar en el acompañamiento de estas pacientes visa la reducción de morbimortalidad materno-fetal. El objetivo de este estudio fue identificar las orientaciones de planificación familiar y conductas contraceptivas en pacientes sometidas a cambio valvar y describe el perfil de la enfermedad de la válvula y el tipo de prótesis. De esta forma se ha hecho un estudio transversal, retrospectivo y descriptivo, realizado en centro de la Bahia en 2009 a 2013. La muestra consiste en pacientes en edad fértil (15 ­ 49 años) sometidas a cambio valvar. Revisados 70 prontuarios, la media de edad fue de 33,67±8,037 años. Acometimiento univalvar ocurrió en 42 casos (60%), teniendo como diagnostico predominante Insuficiencia Mitral aislada, con 19 (45,24%). En cuanto al tipos de prótesis utilizadas en la cirugía, 61 (87,1%) pacientes recibieron la biológica mientras nueve (12,9%) metálica. Fue observado que 64 (91,4%) pacientes presentaron cardiopatía reumática. No hubo registro de orientación de planificación familiar. El estudio demuestra comprometimiento predominante univalvar y por insuficiencia mitral y uso preferencial de prótesis biológicas. Se constató aún inexistencia de registro de orientaciones sobre planificación familiar o histórico gestacional en los prontuarios.

ADESÃO ÀS DIRETRIZES PARA INDICAÇÃO CIRÚRGICA NA INSUFICIÊNCIA MITRAL EM SERVIÇO DE REFERÊNCIA EM CARDIOLOGIA / ADHESION TO GUIDELINES FOR THE INDICATION OF SURGICAL MITRAL INSUFFICIENCY SERVICE IN A CARDIOLOGY REFERENCE SERVICE / ADHESIÓN A LAS DIRECTRICES PARA LA INDICACIÓN QUIRÚRGICA EN LA INSUFICIENCIA MITRAL EN SERVICIO DE REFERENCIA EN CARDIOLOGÍA

O objetivo deste estudo foi verificar a concordância dos critérios de indicação cirúrgica identificados com o proposto pelas Diretrizes de Valvopatias da Sociedade Brasileira de Cardiologia dos pacientes submetidos à troca valvar única decorrente de insuficiência mitral no período de 2007 a 2013, bem como estabelecer o perfil biológico clínico e cirúrgico desses. Tratou-se de um estudo transversal, retrospectivo e descritivo, realizado em um centro de cardiologia. A população do estudo consistiu em pacientes submetidos a cirurgias para troca mitral secundária a insuficiência no período de 2007 a 2013. Os resultados informaram que, do total de 70 prontuários revisados, 61% eram de pacientes do sexo masculino. A idade média foi de 45 anos. Após a análise das informações, notou-se que, em 17%, não foram identificados critérios indicados nas diretrizes. Nesses casos, evidenciou-se uma tendência (63%) à intervenção precoce da lesão. Critérios específicos de indicação foram revelados em 68%, enquanto que em 15% os dados estavam incompletos. Quanto às classes funcionais da New York Heart Association estavam distribuídos entre II (13%) e III/IV (77%). Além disso, 56% apresentavam histórico de febre reumática. Dos resultados ecocardiográficos 81% apresentavam insuficiência mitral importante, enquanto 9% apresentavam moderada. Não foram registrados óbitos intraoperatórios, porém 9% apresentaram complicações. Em 75% optou-se por utilização de valva biológica. Concluiu-se que houve moderada adesão aos critérios de indicação e o perfil biológico clínico e cirúrgico desses pacientes foi compatível com a literatura.

The purpose of this study was to verify the agreement of the surgical indication criteria identified with the proposition by the Brazilian Society of Cardiology Valvopathy Guidelines for patients submitted to single valve replacement due to mitral insufficiency from 2007 to 2013, as well as to establish the biological clinical and surgical profile. This was a cross-sectional, retrospective and descriptive study carried out in a cardiology center. The study population consisted of patients undergoing surgeries for mitral secondary replacement due to failure in the period from 2007 to 2013. The results reported that from the total of 70 charts reviewed, 61% were male patients. The average age was 45 years. After analyzing the information, it was noted that for 17%, no criteria indicated in the guidelines were identified. In these cases, there was a tendency (63%) of early intervention to the lesion. Specific indication criteria were revealed in 68%, while in 15% the data were incomplete. The functional classes of the New York Heart Association were distributed between II (13%) and III / IV (77%). In addition, 56% had a history of rheumatic fever. From echocardiographic findings, 81% had significant mitral regurgitation, while 9% had moderate mitral insufficiency. No intraoperative deaths were recorded, but 9% had complications. In 75% we chose to use biological valve. In conclusion, there was moderate adherence to the indication criteria and the biological and clinical profile of these patients was compatible with the literature.

El objetivo de este estudio fue verificar la concordancia de los criterios de indicación quirúrgica identificados con el propuesto por las Directrices de Valvopatias de la Sociedad Brasileña de Cardiología de los pacientes sometidos al cambio valvular único resultante de insuficiencia mitral en el período de 2007 a 2013, así como establecer el perfil biológico y los procedimientos quirúrgicos. Se trató de un estudio transversal, retrospectivo y El objetivo de este estudio fue verificar la concordancia de los criterios de indicación quirúrgica identificados con el propuesto por las Directrices de Valvopatias de la Sociedad Brasileña de Cardiología de los pacientes sometidos al cambio valvular único resultante de insuficiencia mitral en el período de 2007 a 2013, así como establecer el perfil biológico y los procedimientos quirúrgicos. Se trató de un estudio transversal, retrospectivo y descriptivo, realizado en un centro de cardiología. La población del estudio consistió en pacientes sometidos a cirugías para cambio mitral secundario debido a insuficiencia en el período de 2007 a 2013. Los resultados informaron que del total de 70 prontuarios revisados, el 61% eran de pacientes del sexo masculino. La edad media fue de 45 años. Después del análisis de las informaciones, se notó que, en el 17%, no se identificaron criterios indicados en las directrices. En estos casos, se evidenció una tendencia (63%) a la intervención temprana de la lesión. Los criterios específicos de indicación se revelaron en un 68%, mientras que en el 15% los datos estaban incompletos. En cuanto a las clases funcionales de la New York Heart Association se distribuyeron entre el II (13%) y el III / IV (77%). Además, el 56% presentaba un historial de fiebre reumática. De los resultados ecocardiográficos el 81% presentaba insuficiencia mitral importante, mientras que el 9% presentaba moderada. No se registraron muertes intraoperatorias, pero el 9% presentó complicaciones. En un 75% se optó por la utilización de la válvula biológica. Se concluyó que hubo moderada adhesión a los criterios de indicación y el perfil biológico clínico y quirúrgico de esos pacientes fue compatible con la literatura.

Educação médica: desafio da humanização na formação / Medical education: Challenges of humanization in training

A formação essencialmente biomédica já não atende às necessidades de saúde da sociedade. A educação médica tem sido desafiada a assumir um currículo comprometido com uma práxis humanizada. Este estudo analisa a percepção do docente sobre a proposta humanística no currículo do curso de medicina de uma instituição privada de ensino. Pesquisa exploratória descritiva, de natureza qualitativa, realizada com 19 docentes. Dados analisados por meio da técnica de análise de conteúdo, que gerou três categorias: Como é (des) envolvido o humanismo no currículo de medicina, com quatro subcategorias: intuitiva, formação profissional, cuidado singular e investimento institucional; Como pode ser (des)envolvido o humanismo no currículo, com cinco subcategorias: organização curricular, conteúdo, metodologia, formação dos profissionais e pesquisa; Limitações para o (des)envolvimento do humanismo no currículo, com duas subcategorias: currículo e vem de berço. A discussão evidencia que o humanismo é abordado no currículo, porém, apresenta-se de forma desarticulada, revelando que o tratamento dado ao tema está vinculado a componentes específicos e ao cenário no qual é desenvolvido, assim como à prática individual do docente. Isso destaca a necessidade de uma elaboração coletiva de estratégias que fortaleçam a práxis pedagógica docente com base nos princípios humanísticos.(AU)

Considering University as a powerful territory of social changing, this study discuss the humanistic formation and it possibilities on medical formation. The Objective is investigate how docents understand and reproduce the humanistic formation in it pedagogic practice. As method realizes an exploratory descriptive study (qualitative approach), that 19 docents, of a private institution of higher education, identified as leaders, answered a semi-structured quiz. The analysis of the results indicate three categories : The docents recognizes the theme as important, claim it development based on personal references and common sense perspectives differing of an ethic-epistemological perspective; The docents recognizes the need of institutional compromise and suggest possibilities of development based on inclusion of disciplines, thematic axis and interdisciplinary manners, using actives teaching methods; The docents identify as limiter for the development, the belief of scientific objectivity (that separate docent practices and professional) and the conception that the humanization is only possible if was related to a social-genetic legacy. The final consideration reflex about the importance of including humanistic themes in a live curriculum context. That could fortify the pedagogic-docent praxis, bounded structurally to public health politics. (AU)

A Literatura como Estratégia para Reflexões sobre Humanismo e Ética no Curso Médico: um Estudo Qualitativo / Literature as a Reflexive Strategy on Humanism and Ethics in Medical Education: A Qualitative Study

RESUMO A educação, pilar social caracterizado pela nobreza e complexidade, tem passado por um processo de transição paradigmática: do modelo unilateral e vertical de ensino para outro mais dinâmico, que permite o diálogo aberto entre docente e discente. Analogamente, a medicina contemporânea também vivencia um momento de mudanças, em que há uma necessidade crescente de preparar o futuro médico para lidar cada vez mais com os dilemas e conflitos presentes no cotidiano da área da saúde. A literatura de ficção constitui um recurso didático que segue a linha da metodologia ativa e permite a reflexão, o debate e o confronto de ideias. O presente estudo pretendeu identificar as contribuições do uso da literatura, em especial do livro Ensaio sobre a cegueira, de José Saramago, na formação humanística do estudante de Medicina. Para isto, desenvolveu-se um estudo descritivo, de análise qualitativa e com a participação dos alunos do primeiro ano de Medicina no componente curricular Ética e Bioética da Escola Bahiana de Medicina e Saúde Pública. Com base na leitura da obra de Saramago, os alunos responderam a uma avaliação processual desse componente. Segundo o conteúdo das respostas dos alunos, foram obtidos quatro temas: observação do mundo e do exercício profissional pelo estudante de Medicina; humanização na prática médica diante da invisibilidade social; prática médica tecnocêntrica e humanização; percepção do estudante de Medicina sobre a importância da literatura em sua formação. A diversidade, a riqueza e a verticalidade das respostas apresentadas permitem concluir que a leitura do livro Ensaio sobre a cegueira contribuiu de maneira positiva na aprendizagem dos princípios éticos e bioéticos (beneficência, não maleficência, autonomia e justiça), tendo acrescentado à formação pessoal e profissional dos estudantes. Entretanto, como a experiência da leitura foi de caráter individual, não há meios de assegurar que a contribuição tenha sido de mesma magnitude para todos os alunos.

ABSTRACT Education is a social pillar characterized by its nobility and complexity and has undergone a paradigmatic shift from the unilateral and vertical teaching model to a more dynamic one, facilitating an open dialogue between teachers and students. Contemporary medicine has experienced a similar period of change, creating a growing need to better prepare medical students for dealing with dilemmas and conflicts in the healthcare field. Literary fiction is a teaching tool that follows the line of the active methodology and allows for reflection, debate, and a confrontation of ideas. This study aimed to identify the benefits of using literature as part of the medical degree, with a particular focus on “Blindness” by José Saramago. To this end, we developed a descriptive study featuring qualitative analysis, involving participation of first-year medical students who have attended the Ethics and Bioethics course at the Bahía School of Medicine and Public Health. After reading Saramago’s work, students answered a procedural evaluation of the said component. Four themes emerged upon our thematic analysis of student responses: observation of the world and professional practice by medical students; humanization of medical practice in the face of social invisibility; technocentric medical practice and humanization; and medical students’ awareness of the importance of literature in their training. The diversity, richnes and verticality of the responses submitted suggest that the reading of “Blindness” contributed positively to the students’ learning of ethical and bioethical principles (beneficence, non-maleficence, autonomy, and justice) and added to their personal and professional formation. As reading is an individual experience, however, there is no way to ensure that the contribution was of the same magnitude for all students.

Aspectos éticos dos transplantes de órgãos na visão do estudante de medicina: um estudo comparativo / Ethical aspects of organ transplantation from medical students perspective: a comparative study / Aspectos éticos de los trasplantes de órganos en la visión del estudiante de medicina: un estudio comparativo

O objetivo deste trabalho foi avaliar o conhecimento e a opinião dos estudantes de medicina acerca dos aspectos éticos relacionados à temática dos transplantes de órgãos em diferentes períodos (1º e 4º ano) do curso médico e compará-los. Por meio da aplicação e análise de questionário pré-codificado a amostra composta por 190 estudantes de medicina (95 do 1º ano e 95 do 4º ano) em uma faculdade da cidade de Salvador, Bahia, Brasil, abrangendo aspectos sociodemográficos e relacionados a transplantes e doação de órgãos, concluiu-se que o nível de conhecimento dos participantes acerca desses temas foi insatisfatório em ambos os grupos. Houve notável predileção por aspectos práticos dos transplantes em detrimento dos antropológicos, e, em alguns momentos, os estudantes manifestaram atitude antiética perante os dilemas relacionados à temática.

The objective of this study was to evaluate and compare the knowledge and opinion of medical students from different years (1st and 4th year) of medical school regarding the ethical aspects related to the topic of organ transplantation. A pre-coded questionnaire covering sociodemographic aspects and matters related to transplants and organ donation was applied to a sample of 190 medical students (95 from 1st year and 95 from 4th year) from a college in Salvador (Brazil). It was concluded that the level of students’ knowledge regarding transplantation and organ donation was unsatisfactory in both groups. There was remarkable preference for practical aspects of transplantation to the detriment of anthropological ones, and at times students expressed unethical attitudes towards the dilemmas related to the theme in question.

El objetivo de este estudio fue evaluar el conocimiento y la opinión de los estudiantes de medicina sobre los aspectos éticos relacionados con el tema de los trasplantes de órganos y compararlos de acuerdo a los diferentes períodos (primero y cuarto año) de la escuela de medicina. Mediante la aplicación y el análisis de un cuestionario pre-codificado para una muestra compuesta por 190 estudiantes de medicina (95 de 1º año y 95 de 4º año), en una facultad de la ciudad de Salvador, Bahia, Brasil, incluyendo aspectos sociodemográficos y relacionados a los trasplantes y a la donación de órganos, se concluyó que el nivel de conocimiento de los estudiantes sobre el trasplante y la donación de órganos fue insatisfactorio en ambos grupos. Hubo una notable predilección por los aspectos prácticos de los trasplantes en detrimento de los antropológicos y, en ocasiones, los estudiantes manifestaron una actitud antiética frente a los dilemas relacionados con la temática en cuestión.

Health-related quality of life of medical students in a Brazilian student loan programme.

This study aimed to evaluate the health-related quality of life of medical students participating in a large Brazilian government loan programme for undergraduate students in private schools.A cross-sectional study in a stratified sample of students from a private medical school in Salvador, Brazil, evaluated their health-related quality of life by using a Brazilian Portuguese version of the 36-item Short Form Health Survey questionnaire (SF-36).Students supported by the loan programme consistently presented lower mean scores in all SF-36 domains and in the physical and mental component summary scores than those who were not in the programme. Students supported by the loan programme presented systematically lower physical and mental component mean scores, after stratification by age, gender, school year, physical activity, sleepiness, headache, having a car, having a housemaid, living with family, and living in a rented house.The loan programme has enabled less wealthy undergraduate students to attend private medical schools in Brazil. However, this support is insufficient to improve students' health-related quality of life during medical school, as compared with students who do not participate in the programme. Because of a poorer health-related quality of life, students supported by the loan programme deserve special attention from private medical schools.

Acute Poisoning in Children in Bahia, Brazil.

Acute poisoning is a frequent accident in childhood, particularly in children under 4 years of age. This was a descriptive study with data collected from standardized forms of the Poison Control Center and patient record charts. All the cases of acute poisoning in children aged 0 to 14 years during the period 2008 to 2012 were selected. The variables studied comprised characteristics of the events and toxic agents, clinical development, and outcome. A total of 657 cases of acute poisoning, with higher frequency in the age-group from 1 to 4 years (48.7%) and male sex (53.4%), were recorded. The occurrences were accidental in 92% of the cases, and 5.8% were due to suicide attempts. Among the toxic agents, medications (28.5%), venomous animals (19.3%), nonvenomous animals (10%), household cleaning products (9.0%), and raticide agents (8.7%) predominated. The majority of cases were characterized as light (73.5%) and around 18% required hospitalization, and there was low lethality (0.5%).

Avaliação de programa de apoio diagnóstico no ensino médico / Diagnostic support program evaluation in medical education

OBJETIVO: avaliar a usabilidade do sistema de apoio diagnóstico, em estudo, com a escala SUS (System Usability Scale) por estudantes e professores do curso de medicina. MÉTODOS: estudo de corte transversal aplicado em amostra de conveniência de estudantes e professores do curso de medicina. O aplicativo e questionários de avaliação foram disponibilizados de forma on-line, utilizado a escala de usabilidade do SUS, para avaliação do sistema. RESULTADOS: Quanto ao escore da usabilidade com SUS a média total foi de 63,62 (±16,61), no grupo de professores 62,66 (±9,23) e de estudantes64,64 (±22,77) sem diferença estatística entre os grupos, embora com tendência de maior valor no escore para os estudantes. CONCLUSÃO: Verificada boa receptividade para a utilização do Sistema de Apoio a Decisões Clínicas no contexto da educação médica. Professores e estudantes contribuíram de forma efetiva para o aprimoramento do aplicativo.

OBJECTIVE: To evaluate the usability of the diagnostic support system, using the SUS scale (System Usability Scale) on students and medical school professors. METHODS: Cross-sectional study using a convenience sample of medical students and teachers of the course. The application, evaluation questionnaires and SUS were made available through an online form. RESULTS: The mean SUS score was 63.62 (± 16.61) among all participants, it was 62.66 (± 9.23) among teachers and 64.64 (± 22.77) for students, without statistic difference between the groups, although with a trend of highest score for students. CONCLUSION: The receptivity to the use of Decision Support Clinical System in the context of medical education was good. Teachers and students have contributed effectively to the application improvement.