Comunicação em saúde entre graduandos de odontologia e seus pacientes / Health communication between undergraduate dental students and their patients

O presente estudo teve por objetivo avaliar técnicas de comunicação utilizadas pelos graduandos de odontologia, incentivando-os a refletirem sobre seu atendimento, bem como analisar a maneira que os pacientes creem ser atendidos. Foram coletados dados de 164 estudantes do terceiro, quarto e quinto ano por meio do instrumento Student Communication Assessment Instrument (SCAI) e de 164 pacientes atendidos na clínica de odontologia do Centro Universitário da Fundação Hermínio Ometto (FHO), por meio do instrumento Patient Communication Assessment Instrument (PCAI). Ambos os instrumentos apresentam 28 questões relacionadas a 3 categorias (1-sendo atencioso e respeitoso, 2- compartilhando informações, 3- cuidando do seu bem-estar). O PCAI apresenta mais uma categoria com 3 questões relacionadas a experiência com o tratamento odontológico. Todas as questões contendo uma escala de comunicação (ruim/médio/bom/muito bom/excelente). Os resultados mostraram concordâncias superiores a 98% na categoria 1,93% na categoria 2 e na categoria 3, e 96% de concordância na escala bom/muito bom/excelente. Em relação a categoria 4, exclusiva aos pacientes, mais de 92% apontaram como muito bom e excelente em relação a sua experiência com o tratamento odontológico oferecido. Conclui-se que, estudantes e pacientes avaliaram as técnicas de comunicação, sobre atendimento clínico, de forma análoga na escala bom/muito bom/excelente, o que refletiu na satisfação do paciente com o tratamento odontológico

Comunicação em saúde entre graduandos de odontologia e seus pacientes / Health communication between undergraduate dental students and their patients

O presente estudo teve por objetivo avaliar técnicas de comunicação utilizadas pelos graduandos de odontologia, incentivando-os a refletirem sobre seu atendimento, bem como analisar a maneira que os pacientes creem ser atendidos. Foram coletados dados de 164 estudantes do terceiro, quarto e quinto ano por meio do instrumento Student Communication Assessment Instrument (SCAI) e de 164 pacientes atendidos na clínica de odontologia do Centro Universitário da Fundação Hermínio Ometto (FHO), por meio do instrumento Patient Communication Assessment Instrument (PCAI). Ambos os instrumentos apresentam 28 questões relacionadas a 3 categorias (1-sendo atencioso e respeitoso, 2- compartilhando informações, 3- cuidando do seu bem-estar). O PCAI apresenta mais uma categoria com 3 questões relacionadas a experiência com o tratamento odontológico. Todas as questões contendo uma escala de comunicação (ruim/médio/bom/muito bom/excelente). Os resultados mostraram concordâncias superiores a 98% na categoria 1,93% na categoria 2 e na categoria 3, e 96% de concordância na escala bom/muito bom/excelente. Em relação a categoria 4, exclusiva aos pacientes, mais de 92% apontaram como muito bom e excelente em relação a sua experiência com o tratamento odontológico oferecido. Conclui-se que, estudantes e pacientes avaliaram as técnicas de comunicação, sobre atendimento clínico, de forma análoga na escala bom/muito bom/excelente, o que refletiu na satisfação do paciente com o tratamento odontológico

Inovação responsável através de fronteiras: tensões, paradoxos e possibilidades

In March 2014 a group of early career researchers and academics from São Paulo state and from the UK met at the University of Campinas to participate in a workshop on ‘Responsible Innovation and the Governance of Socially Controversial Technologies’. In this Perspective we describe key reflections and observations from the workshop discussions, paying particular attention to the discourse of responsible innovation from a cross-cultural perspective. We describe a number of important tensions, paradoxes and opportunities that emerged over the three days of the workshop

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

ATLANTIC-PRIMATES: a dataset of communities and occurrences of primates in the Atlantic Forests of South America

Primates play an important role in ecosystem functioning and offer critical insights into human evolution, biology, behavior, and emerging infectious diseases. There are 26 primate species in the Atlantic Forests of South America, 19 of them endemic. We compiled a dataset of 5,472 georeferenced locations of 26 native and 1 introduced primate species, as hybrids in the genera Callithrix and Alouatta. The dataset includes 700 primate communities, 8,121 single species occurrences and 714 estimates of primate population sizes, covering most natural forest types of the tropical and subtropical Atlantic Forest of Brazil, Paraguay and Argentina and some other biomes. On average, primate communities of the Atlantic Forest harbor 2 ± 1 species (range = 1–6). However, about 40% of primate communities contain only one species. Alouatta guariba (N = 2,188 records) and Sapajus nigritus (N = 1,127) were the species with the most records. Callicebus barbarabrownae (N = 35), Leontopithecus caissara (N = 38), and Sapajus libidinosus (N = 41) were the species with the least records. Recorded primate densities varied from 0.004 individuals/km 2 (Alouatta guariba at Fragmento do Bugre, Paraná, Brazil) to 400 individuals/km 2 (Alouatta caraya in Santiago, Rio Grande do Sul, Brazil). Our dataset reflects disparity between the numerous primate census conducted in the Atlantic Forest, in contrast to the scarcity of estimates of population sizes and densities. With these data, researchers can develop different macroecological and regional level studies, focusing on communities, populations, species co-occurrence and distribution patterns. Moreover, the data can also be used to assess the consequences of fragmentation, defaunation, and disease outbreaks on different ecological processes, such as trophic cascades, species invasion or extinction, and community dynamics. There are no copyright restrictions. Please cite this Data Paper when the data are used in publications. We also request that researchers and teachers inform us of how they are using the data. © 2018 by the The Authors. Ecology © 2018 The Ecological Society of Americ

GIS-Based Approach Applied to Study of Seasonal Rainfall Influence over Flood Vulnerability

Flooding occurrence is one of the most common phenomena that impact urban areas, and this intensifies during heavy rainfall periods. Knowing the areas with the greatest vulnerability is of paramount importance as it allows mitigating actions to be implemented in order to minimize the generated impacts. In this context, this study aimed to use Geographic Information System (GIS) tools to identify the areas with greater flooding vulnerability in Espírito Santo state, Brazil. The study was based on the following methodological steps: (1) a Digital Elevation Model (DEM) acquisition and watersheds delimitation; (2) maximum and accumulated rainfall intensity calculations for the three studied periods using meteorological data; (3) a land use and occupation map reclassification regarding flood vulnerability and fuzzy logic application; (4) an application of Euclidean distance and fuzzy logic in hydrography and water mass vector variables; (5) a flood vulnerability model generation. Based on the found results, it was observed that the metropolitan and coastal regions presented as greater flood vulnerability areas during the dry season, as in these regions, almost all of the 9.18% of the state’s area was classified as highly vulnerable, while during rainy season, the most vulnerable areas were concentrated in Caparaó and in the coastal and immigration and metropolitan regions, as in these regions, almost all of the 12.72% of the state’s area was classified as highly vulnerable. In general, by annually distributing the rainfall rates, a greater flood vulnerability was observed in the metropolitan and coastal and immigration regions, as in these areas, almost all of the 7.72% of the state’s area was classified as highly vulnerable. According to the study, Espírito Santo state was mostly classified as a low (29.15%) and medium (28.06%) flood vulnerability area considering the annual period, while its metropolitan region has a very high flood vulnerability risk. Finally, GIS modeling is important to assist in decision making regarding public management and the employed methodology presents worldwide application potential

GIS-Based Approach Applied to Study of Seasonal Rainfall Influence over Flood Vulnerability

Flooding occurrence is one of the most common phenomena that impact urban areas, and this intensifies during heavy rainfall periods. Knowing the areas with the greatest vulnerability is of paramount importance as it allows mitigating actions to be implemented in order to minimize the generated impacts. In this context, this study aimed to use Geographic Information System (GIS) tools to identify the areas with greater flooding vulnerability in Espírito Santo state, Brazil. The study was based on the following methodological steps: (1) a Digital Elevation Model (DEM) acquisition and watersheds delimitation; (2) maximum and accumulated rainfall intensity calculations for the three studied periods using meteorological data; (3) a land use and occupation map reclassification regarding flood vulnerability and fuzzy logic application; (4) an application of Euclidean distance and fuzzy logic in hydrography and water mass vector variables; (5) a flood vulnerability model generation. Based on the found results, it was observed that the metropolitan and coastal regions presented as greater flood vulnerability areas during the dry season, as in these regions, almost all of the 9.18% of the state’s area was classified as highly vulnerable, while during rainy season, the most vulnerable areas were concentrated in Caparaó and in the coastal and immigration and metropolitan regions, as in these regions, almost all of the 12.72% of the state’s area was classified as highly vulnerable. In general, by annually distributing the rainfall rates, a greater flood vulnerability was observed in the metropolitan and coastal and immigration regions, as in these areas, almost all of the 7.72% of the state’s area was classified as highly vulnerable. According to the study, Espírito Santo state was mostly classified as a low (29.15%) and medium (28.06%) flood vulnerability area considering the annual period, while its metropolitan region has a very high flood vulnerability risk. Finally, GIS modeling is important to assist in decision making regarding public management and the employed methodology presents worldwide application potential

Feasibility of a mobile app to improve inhaler adherence in real‐world patients with asthma: A multicentre observational study in Portugal and Spain

InspirerMundi app aims to transform adherence into a positive experience through gamification and social support, while allowing objective monitoring of inhaler adherence. This study assessed the feasibility of the app in adolescents and adults with persistent asthma.info:eu-repo/semantics/publishedVersio

Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence : Mixed Methods Study

Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring >= 4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85%), gamification and social network (33/79, 42%), symptom monitoring and physician communication (21/79, 27%), and other aspects (16/79, 20%). Conclusions: The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit