Perceptions of primary healthcare professionals towards their role in type 2 diabetes mellitus patient education in Brazil

<p>Abstract</p> <p>Background</p> <p>The aim of the current study was to analyze the perceptions, knowledge, and practices of primary healthcare professionals in providing patient education to people with type 2 diabetes mellitus.</p> <p>Methods</p> <p>A total of 23 health professionals working in primary healthcare units in Belo Horizonte, Minas Gerais State, Brazil, participated in a focus group in order to discuss their patient education practices and the challenges for effective patient education in diabetes self-management.</p> <p>Results</p> <p>The results were categorized as follows: 1) lack of preparation and technical knowledge among the health professionals on some aspects of diabetes mellitus and the health professionals' patient education practices; 2) work conditions and organization; 3) issues related or attributed to the clientele themselves; and 4) diabetes care model.</p> <p>Conclusions</p> <p>This study highlights the importance of reorienting the patient education practices, health professionals' skills and work goals, and evaluation of the educational interventions, in order to establish strategies for health promotion and prevention and control of the disease.</p> <p>Descriptors</p> <p>Health Education; Prevention of Diabetes Mellitus; Primary Healthcare</p

Capacitação de profissionais da atenção primária à saúde para educação em Diabetes Mellitus Capacitación, de profesionales que actúan en la atención primaria a la salud, en educación en Diabetes Mellitus Training of professionals, acting in primary health care, in Diabetes Mellitus education

OBJETIVO: Apresentar o delineamento das oficinas educativas em Diabetes Mellitus e uma estratégia avaliativa voltada à atualização dos profissionais de saúde da atenção primária. MÉTODOS: As oficinas foram implementadas, utilizando metodologia participativa, técnicas lúdicas, vivências e dinâmicas de grupo, envolvendo a participação de 85 profissionais de saúde das Unidades Básicas de Saúde de Belo Horizonte/MG. Os conhecimentos sobre a doença e as competências requeridas para o autocuidado foram aferidos mediante a aplicação de instrumento especifico. As oficinas foram avaliadas com base em instrumento próprio. RESULTADOS: Foram observadas limitações no conhecimento dos profissionais centrados na fisiopatologia e nos exames complementares da doença. As oficinas contribuíram para o despertar do potencial reflexivo, crítico e criativo dos profissionais para a mudança no processo educativo. Foi considerada uma estratégia pedagógica, de fácil compreensão, interativa e lúdica. CONCLUSÕES: As oficinas contribuíram para o planejamento do processo educativo e a estruturação de um modelo de avaliação das práticas de promoção, da saúde e educação em Diabetes.<br>OBJETIVO: Presentar el proyecto de talleres educativos sobre diabetes y una estrategia de evaluación dirigida a la actualización de los profesionales de la salud en la atención primaria. MÉTODOS: Los talleres se llevaron a cabo utilizando la metodología participativa, las técnicas de juego, las experiencias y dinámicas de grupo, con la participación de 85 profesionales de la salud de las Unidades Básicas de Salud de Belo Horizonte, MG. El conocimiento sobre la enfermedad y las habilidades necesarias para el autocuidado fueron evaluados mediante la aplicación de instrumentos específicos. Los talleres fueron evaluados con base en instrumento propio. RESULTADOS: Se encontraron limitaciones en el conocimiento de los profesionales centrados en la fisiopatología y en las pruebas complementarias de la enfermedad. Los talleres ayudaron a despertar el potencial de reflexión, de crítica y de creatividad de los profesionales, que se necesita para cambiar el proceso educativo. Fue considerada una estrategia pedagógica, fácil de entender, interactiva y lúdica. CONCLUSIONES: Los talleres contribuyeron para la planificación del proceso educativo y la estructuración de un modelo de evaluación de las prácticas de promoción de la salud y de la educación en diabetes.<br>OBJECTIVE: To present the proposal of educational workshops on diabetes and a strategy of evaluation aimed at upgrading the professionals' performance in primary care. METHODS: The workshops were implemented using participatory methodology, play techniques, experiences, and group dynamics, involving the participation of 85 health professionals from Units of Primary Care, in the city of Belo Horizonte, MG. The knowledge about the disease and the skills required for self-care were measured by applying specific instruments. The workshops were evaluated based on the instrument developed for that purpose. RESULTS: There were limitations in the knowledge of professionals about pathophysiology and the disease's complementary tests. The workshops helped to awaken the potential of professionals (reflection, criticism and creativity) necessary to change the educational process. It was considered a pedagogical strategy, easy to understand, interactive and playful. CONCLUSIONS: The workshops contributed to the planning of the educational process and the structuring of an evaluation model of practices of health and education promotion in diabetes

A atuação do nutricionista na Atenção Básica à Saúde em um grande centro urbano The participation of the nutritionist in Primary Health Care in a large urban center

O nutricionista é um profissional importante na implementação de ações de promoção, tratamento e reabilitação da saúde. Porém, sua participação na Atenção Básica (AB) é reduzida. A cidade de São Paulo vem passando por um processo desigual de urbanização, produzindo novas situações de insegurança alimentar e nutricional. Este trabalho analisará a atuação do nutricionista na AB em um grande centro urbano. Trata-se de estudo de abordagem quantitativa no qual foram utilizados dados populacionais da Secretaria Municipal de Saúde e um questionário semiestruturado aplicado em entrevistas individuais. Encontraram-se 123 nutricionistas atuando na rede Básica de Saúde e 51 em Núcleos de Apoio à Saúde da Família (NASF). Todas as regiões do município apresentaram-se com menor número de nutricionistas quando comparada à recomendação do Conselho Federal de Nutricionistas. Em 57,3% dos NASF do município identificou-se a presença deste profissional. Cada nutricionista de NASF acompanha, em média, 7,1 equipes de saúde da família. As faixas etárias que correspondem à infância são as atendidas com menor frequência pelos nutricionistas das UBS e dos NASF. Comparando-se as atividades desenvolvidas, observa-se a transição de um modelo de assistência primária centrado no atendimento individual para um que prioriza o atendimento em grupo.<br>Nutritionists are important professionals for ensuring the implementation of health promotion, treatment and rehabilitation. However, their participation in primary healthcare from a quantitative standpoint is limited. The city of São Paulo has experienced an uneven urbanization process triggering new problems of insecurity in terms of food and nutrition. This article analyzes the performance of the primary healthcare nutritionist in a large urban center. It is a quantitative study that used data from the Municipal Health Department, population data of São Paulo and a semi-structured questionnaire applied in individual interviews. All regions of the city are found to have fewer nutritionists than the recommendation of the Federal Council of Nutritionists. There are 123 nutritionists in the basic healthcare network and 51 in the Family Health Support Nuclei (FHSN) (57.3%). Each nutritionist from the FHSN accompanies 7.1 family health strategy teams on average. The age groups corresponding to children are less frequently seen by nutritionists. Comparing the activities, the transition from a model of primary health care focused on individual care to a model that prioritizes group care was observed

Differential expression of FAK and Pyk2 in metastatic and non-metastatic EL4 lymphoma cell lines

The murine EL4 lymphoma cell line exists in variants that are either sensitive or resistant to phorbol 12-myristate 13-acetate (PMA). In sensitive cells, PMA causes Erk MAPK activation and Erk-mediated growth arrest. In resistant cells, PMA induces a low level of Erk activation, without growth arrest. A relatively unexplored aspect of the phenotypes is that resistant cells are more adherent to culture substrate than are sensitive cells. In this study, the roles of the protein tyrosine kinases FAK and Pyk2 in EL4 phenotype were examined, with a particular emphasis on the role of these proteins in metastasis. FAK is expressed only in PMA-resistant (or intermediate phenotype) EL4 cells, correlating with enhanced cell-substrate adherence, while Pyk2 is more highly expressed in non-adherent PMA-sensitive cells. PMA treatment causes modulation of mRNA for FAK (up-regulation) and Pyk2 (down-regulation) in PMA-sensitive but not PMA-resistant EL4 cells. The increase in Pyk2 mRNA is correlated with an increase in Pyk2 protein expression. The roles of FAK in cell phenotype were further explored using transfection and knockdown experiments. The results showed that FAK does not play a major role in modulating PMA-induced Erk activation in EL4 cells. However, the knockdown studies demonstrated that FAK expression is required for proliferation and migration of PMA-resistant cells. In an experimental metastasis model using syngeneic mice, only FAK-expressing (PMA-resistant) EL4 cells form liver tumors. Taken together, these studies suggest that FAK expression promotes metastasis of EL4 lymphoma cells