Development of a low-cost congenital abdominal wall defect simulator (wall-go) for undergraduate medical education: a validation study.

BACKGROUND: Congenital Anomalies were responsible for 303,000 deaths in the neonatal period, according to the WHO, they are among the world's top 20 causes of morbidity and mortality. Expensive simulators demonstrate several diseases, but few are related to congenital anomalies. This study aims to develop, validate, and evaluate low-cost simulator models (WALL-GO) of the most common abdominal wall defects, gastroschisis, and omphalocele, to enable diagnosis through an accessible tool with study value and amenable to replication. METHODS: Market research was conducted to find materials to build low-cost models. The researchers built the model and underwent validation assessment of the selected experts who scored five or more in the adapted Fehring criteria. The experts were assessed through a 5-point Likert scale to 7 statements (S1-7). Statements were assigned values according to relevance in face and transfer validities. Concomitantly, the model was also evaluated by students from 1st to 5th year with the same instruments. Content Validity Indexes (CVIs) were considered validated between groups with concordance greater than 90%. Text feedback was also collected. Each statement was subjected to Fisher's Exact Test. RESULTS: Gastroschisis and omphalocele model costs were US $15 and US $27, respectively. In total, there were 105 simulator evaluators. 15 experts were selected. Of the 90 students, there were 16 (1st year), 22 (2nd), 16 (3rd), 22 (4th), and 14 (5th). Students and experts obtained CVI = 96.4% and 94.6%, respectively. The CVIs of each statement were not significantly different between groups (p < 0,05). CONCLUSIONS: The WALL-GO models are suitable for use and replicable at a manufacturable low cost. Mannequins with abdominal wall defects are helpful in learning to diagnose and can be applied in teaching and training health professionals in developing and low-income countries.

Underreporting of diabetes mellitus as the cause of death in Bauru, State of São Paulo, Brazil over 40 years: a documental study

ABSTRACT Objective To evaluate, characterize and search for trends in the underreporting of diabetes mellitus (DM) as the cause of death in Bauru, São Paulo, Brazil, over 40 years. Subjects and methods This was a documental study. Clinical and mortality data were collected from individuals known to have type 1 (DM1) and type 2 diabetes mellitus (DM2), residing in Bauru, State of São Paulo, followed at a local endocrinology clinic from 1982 to 2021, who deceased during this period. Results A significant underreporting of DM as the cause of death (64.41%) was found, mostly associated with male gender (OR = 1.59 [95% CI: 1.18; 2.15]; p < 0.01), DM2 (OR = 2.64 [95% CI: 1.32; 5.26]; p < 0.01), dying in the first decade of the study (OR = 4.07 [95% CI: 1.54; 10.71]; p < 0.001) and shorter DM duration (OR = 1.02 [95% CI: 1.01; 1.04]; p < 0.01). Age, type of treatment, body mass index, marital status and ethnicity, did not show a significant association with DM underreporting. There was a decreasing trend in DM1 underreporting (Decade Percentual Change = -7.10 [95% CI: -11.35; -3.40]), but a stationary trend for DM and DM2. The main primary cause of death was cardiovascular-related complications. Conclusion The underreporting of DM as the cause of death was very frequently found, and was associated with male gender, decade of death, shorter DM duration and DM2. If our data could be applied to the whole country, DM would possibly emerge as a more prominent cause of death in Brazil. Future studies in other cities and geographic regions are warranted to confirm our findings.