Effectiveness of interprofessional education by on-field training for medical students, with a pre-post design

open3noBACKGROUND: Interprofessional Education (IPE) implies how to achieve successful teamwork, and is based on collaborative practice which enhance occasions for relationships between two or more healthcare professions. This study evaluates the effectiveness of IPE in changing attitudes after a training recently introduced to medical education for second-year students at the University of Padova, Italy. METHODS: All medical students following a new program for IPE were enrolled in this study. The Interdisciplinary Education Perception Scale (IEPS) was administered before and after training, according to observation-based and practice-based learning. Data were analysed with Student's paired t-test and Wilcoxon's signed rank test. RESULTS: 277 medical students completed both questionnaires. Statistically significant improvements were found in students' overall attitudes as measured by the IEPS and four subscale scores. Gender-stratified analyses showed that improvements were observed only in female students in subscale 4 ("Understanding Others' Values"). Students who had a physician and/or health worker in their family did not show any improvement in subscales 2 ("Perceived need for cooperation") or 4 ("Understanding Others' Values"). CONCLUSIONS: Our results indicate that IPE training has a positive influence on students' understanding of collaboration and better attitudes in interprofessional teamwork. More research is needed to explore other factors which may influence specific perceptions among medical students.openZanotti, Renzo; Sartor, Giada; Canova, CristinaZanotti, Renzo; Sartor, Giada; Canova, Cristin

Risks of hospitalization and drug consumption in children and young adults with diagnosed celiac disease and the role of maternal education: A population-based matched birth cohort study

Background: Celiac disease (CD) may affect healthcare use in children and young adults. Socio-economic factors may act as a confounder or effect modifier. We assessed such hypotheses in a population-based birth cohort of young celiac subjects and references matched by maternal education. Methods: The cohort included all newborns recorded in the Medical Birth Register of Friuli-Venezia Giulia Region (Italy) between 1989 and 2011. CD incident cases were identified through pathology reports, hospital discharges and copayment exemptions and matched with up to five references by sex, year of birth and maternal education. Cox regression models were used to estimate Hazard Ratios (HRs) for major causes of inpatient diagnosis and drug prescription occurring after diagnosis in CD patients compared to references, stratifying by time of first event and maternal education. Results: We identified 1294 CD cases and 5681 references. CD cases had a higher risk of hospital admission for any cause (HR: 2.34; 95 % CI 2.08-2.63) and for all major ICD9-CM categories except obstetric complications, skin and musculoskeletal diseases, and injuries and poisoning. Prescription of all major ATC drug categories, except dermatologicals and genito-urinary medications, was significantly increased in CD subjects. For most outcomes, HRs were highest in the first year after CD diagnosis but remained significant after five or more years. HRs were similar across different categories of maternal education. Conclusions: Diagnosed CD subjects had a higher risk of hospitalization and medication use compared to the general population, even five or more years after diagnosis, with no effect modification of maternal education

Estudo sobre as alterações da função sexual em mulheres com lesão medular resistentes na cidade de Ribeirão Preto/SP

It is known that a person who has suffered a spinal cord injury, in addition to sensitivity, locomotion, intestinal and urinary function impairment, regardless of the injury location, must also face sexual function impairment. Each person reacts differently, no matter how similar the injuries can be. The present study, which was an exploratory, descriptive, transversal, applied field study of quantitative nature, was carried out in three hospitals and two physical therapy clinics in the city of Ribeirao Preto, state of Sao Paulo, Brazil, with the objective of evaluating women with spinal cord injuries treated from January 1, 2000 to July 31, 2004. The study population consisted of 81 women. Thirty women were excluded as they did not meet the inclusion criteria: 12 of them had diagnoses that were not related to spinal cord injury, 11 could not be located, 6 died and one refused to participate in the study. Age range in which the spinal cord injury predominated was 18 to 37 years (38%). After the injury, 27% remained single, 28% remained with their partners; regarding the degree of schooling, Grade School predominated (49%) and 9% were illiterate. They presented traumatic etiology (100%) at the lumbar level (53%), followed by cervical (27%), thoracic (16%) and sacral (4%) levels. Of the external causes of the injury, car accident (29%) was the most prevalent, followed by falls (12%), firearm injury, weight lifting, being hit by a car, and motorcycle accident (8% each), shallow-water diving and being beaten up (2% each), and knife injury, sports activities, fall of object on the head, practicing radical sports and fall from one’s height added up to 16% of the women and among them, 94% are elderly. The “Changes in Sexual Functioning Questionnaire” (CSFQ) scale showed that 90% of the sample presented sexual dysfunction regarding the sexual pleasure variable, orgasm dysfunction (90%), desire/frequency dysfunction (76%), sexual interest dysfunction (72%) and arousal dysfunction (92%). This study confirmed that the patient with spinal cord injury presents specific complexities and particularities and that the scarcity of studies on the specific sexuality of women with spinal cord injuries does not offer a specific care that encompasses the social, psychological and physical dimensions, as well as the continuing homecare, establishing a rehabilitation process without quality.É sabido que qualquer pessoa que sofreu algum dano na medula, além de comprometimento da sensibilidade, locomoção, funções intestinais e urinárias, independente da região lesionada, também acomete a função sexual. Cada pessoa reage de maneira diferente por mais semelhante que seja a lesão. O presente estudo exploratório, descritivo, transversal, aplicado de campo, de natureza quantitativa, foi realizado em três hospitais e duas clínicas de fisioterapia na cidade de Ribeirão Preto, SP, com a finalidade de conhecer as mulheres com lesão medular atendidas no período compreendido entre 1º de janeiro de 2000 a 31 de julho de 2004. A população foi composta por 81 mulheres. Deste total, foram excluídas 30 que não atenderam os critérios de inclusão, 12 delas com diagnósticos não relacionados à lesão medular, 11 não localizadas, seis que faleceram e uma que se recusou a participar da pesquisa. A faixa etária que predominou a lesão medular é dos 18 aos 37 anos (38%). Após a lesão, 27% permaneceram solteiras, 28% com seus companheiros, escolaridade nível de ensino fundamental (49%), analfabetismo (9%). Apresentaram etiologia traumática (100%), nível lombar (53%), seguido do cervical (27%), torácica (16%) e sacral (4%,). Das causas externas constatamos acidente automobilístico (29%), 12% de queda, em terceiro encontra-se o ferimento por arma de fogo (FAF), levantamento de peso, atropelamento e acidente de motocicleta 8% cada, mergulho em águas rasas e espancamento, com 2% cada, ferimento por arma branca (FAB), práticas de atividades esportivas e queda de objeto sobre a cabeça, práticas de esportes radicais, queda da própria altura somaram 16% das mulheres, e dentre estas mulheres 94% são idosas. Quanto à escala CSFQ, 90% da amostra apresenta disfunção sexual em relação à variável prazer, disfunção do orgasmo (90%) disfunção do desejo/freqüência (76%) e 72% disfunção do interesse sexual, excitação 92%. Neste estudo podemos confirmar que a paciente com lesão medular, apresenta complexidade e peculiaridades específicas. E que a escassez de estudos sobre sexualidade especificamente feminina da portadora de lesão medular, não oferece um cuidar específico que permeie as diferentes dimensões sociais, psicológicas e físicas, não assegurando um cuidado holístico e a continuidade deste cuidar em domicílio estabelecendo um processo de reabilitação sem qualidade

ENTRE A DEMOCRATIZAÇÃO E A SOBREVIVÊNCIA: POSSIBILIDADES E DESAFIOS DA POLÍTICA CULTURAL DA NICARÁGUA SANDINISTA

Neste artigo, a política cultural implementada durante a Revolução Sandinista (1979-1990), na Nicarágua, é lida a partir de suas influências internacionais e de seu contexto social e histórico, por meio de análise documental e revisão bibliográfica. O tema se justifica por seu ineditismo, já que a experiência nicaraguense é pouco estudada no país, e pelo diálogo que pode estabelecer com discussões sobre políticas culturais no Brasil. Destaca-se que essa política buscou o acesso crescente das classes excluídas à produção cultural, enfrentou a divisão entre produtores e consumidores de cultura e tentou propor ações conjuntas com as áreas de educação e comunicação

Clean Colon Software Program (CCSP), Proposal of a standardized Method to quantify Colon Cleansing During Colonoscopy: Preliminary Results

Background and study aims: Neoplastic lesions can be missed during colonoscopy, especially when cleansing is inadequate. Bowel preparation scales have significant limitations and no objective and standardized method currently exists to establish colon cleanliness during colonoscopy. The aims of our study are to create a software algorithm that is able to analyze bowel cleansing during colonoscopies and to compare it to a validate bowel preparation scale. Patients and methods: A software application (the Clean Colon Software Program, CCSP) was developed. Fifty colonoscopies were carried out and video-recorded. Each video was divided into 3 segments: cecum-hepatic flexure (1st Segment), hepatic flexure-descending colon (2nd Segment) and rectosigmoid segment (3rd Segment). Each segment was recorded twice, both before and after careful cleansing of the intestinal wall. A score from 0 (dirty) to 3 (clean) was then assigned by CCSP. All the videos were also viewed by four endoscopists and colon cleansing was established using the Boston Bowel Preparation Scale. Interclass correlation coefficient was then calculated between the endoscopists and the software. Results: The cleansing score of the prelavage colonoscopies was 1.56\ub10.52 and the postlavage one was 2,08\ub10,59 (P<0.001) showing an approximate 33.3% improvement in cleansing after lavage. Right colon segment prelavage (0.99\ub10.69) was dirtier than left colon segment prelavage (2.07\ub10.71). The overall interobserver agreement between the average cleansing score for the 4 endoscopists and the software pre-cleansing was 0.87 (95% CI, 0.84\u20130.90) and post-cleansing was 0.86 (95% CI, 0.83\u20130.89). Conclusions: The software is able to discriminate clean from non-clean colon tracts with high significance and is comparable to endoscopist evaluation

Evaluación del riesgo ambiental generado por el derrame de petróleo ocurrido en el litoral marino costero de Ventanilla - Callao, 2022

El derrame de petróleo en el litoral marino costero de Ventanilla originó un problema ambiental significativo. El objetivo general de la presente investigación fue determinar la evaluación del riesgo ambiental generado por el derrame de petróleo ocurrido en el litoral marino costero de Ventanilla - Callao, 2022. El estudio tiene un enfoque cuantitativo, con diseño no experimental, de corte transversal y alcance descriptivo. La técnica de recolección de datos utilizada, fueron la investigación documental y de campo. Los instrumentos y la metodología fueron basadas en la guía de evaluación de riesgos ambientales del Ministerio del Ambiente. Los resultados obtenidos demostraron altos niveles de concentración respecto a los parámetros de TPH y DBO, lo cuales superaron los ECA categoría 2 subcategoría 3; además, se caracterizó el riesgo ambiental obteniendo 70% para el entorno humano, 80% para el entorno ecológico y 40% para el entorno socioeconómico; finalmente, se concluye que el derrame de petróleo ocurrido en el litoral marino costero de Ventanilla, Callao - 2022, presenta un “Riesgo significativo”.The oil spill in the Ventanilla coastal marine littoral created a significant environmental problem. The general objective of the present investigation was to determine the evaluation of the environmental risk generated by the oil spill that occurred on the coastal marine coast of Ventanilla - Callao, 2022. The study has a quantitative approach, with a non-experimental design, cross-sectional and scope descriptive. The data collection technique used was documentary and field research. The instruments and methodology were based on the environmental risk assessment guide of the Ministry of the Environment. The results obtained demonstrated high levels of concentration regarding the parameters of TPH and BOD, which exceeded the RCT category 2 subcategory 3; In addition, the environmental risk was characterized, obtaining 70% for the human environment, 80% for the ecological environment and 40% for the socioeconomic environment; finally, it is concluded that the oil spill occurred on the coastal marine coast of Ventanilla, Callao - 2022, presents a "significant risk"

Ventricular septal defect in sheep - case report / Defeito de septo interventricular em ovino - relato de caso

A 1-month-old uncastrated Ile de France male sheep was diagnosed with an opening in the left interventricular septal. The malformation was evidenced and confirmed through necropsy and observations of systemic histological lesions related to congenital heart disease, especially in the liver, lungs, and heart. Depending on the severity of the defect, the connection promoting free blood transit between the two heart ventricles can be associated with a series of clinical signs culminating in the animal's death. The etiology of congenital malformations in ruminants can be nutritional, toxic, hereditary, or infectious. However, these anomalies are infrequent in sheep; thus, their most common causes are undetermined. The present report describes macro- and microscopic findings related to this congenital malformation in a lamb

Exposure to Perfluoroalkyl Substances and Mortality for COVID-19: A Spatial Ecological Analysis in the Veneto Region (Italy).

BACKGROUND: In the context of the COVID-19 pandemic, there is interest in assessing if per- and polyfluoroalkyl substances (PFAS) exposures are associated with any increased risk of COVID-19 or its severity, given the evidence of immunosuppression by some PFAS. The objective of this paper is to evaluate at the ecological level if a large area (Red Zone) of the Veneto Region, where residents were exposed for decades to drinking water contaminated by PFAS, showed higher mortality for COVID-19 than the rest of the region. METHODS: We fitted a Bayesian ecological regression model with spatially and not spatially structured random components on COVID-19 mortality at the municipality level (period between 21 February and 15 April 2020). The model included education score, background all-cause mortality (for the years 2015-2019), and an indicator for the Red Zone. The two random components are intended to adjust for potential hidden confounders. RESULTS: The COVID-19 crude mortality rate ratio for the Red Zone was 1.55 (90% Confidence Interval 1.25; 1.92). From the Bayesian ecological regression model adjusted for education level and baseline all-cause mortality, the rate ratio for the Red Zone was 1.60 (90% Credibility Interval 0.94; 2.51). CONCLUSION: In conclusion, we observed a higher mortality risk for COVID-19 in a population heavily exposed to PFAS, which was possibly explained by PFAS immunosuppression, bioaccumulation in lung tissue, or pre-existing disease being related to PFAS