Libras na formação médica: possibilidade de quebra da barreira comunicativa e melhora na relação médico-paciente surdo

INTRODUÇÃO: Mudanças curriculares para a graduação em Medicina incluem o desenvolvimento de habilidades de comunicação na graduação do aluno. O conhecimento da Língua Brasileira de Sinais (Libras) pelo médico visa romper barreiras comunicativas com os pacientes surdos e é um bom método para se obter escuta qualificada e excelência do cuidado em saúde. OBJETIVO: Avaliar o contingente de médicos recém-formados pela Universidade Federal de Minas Gerais (UFMG) que domina a Libras. MÉTODOS: Entrevista aplicada aos alunos do 12° período do curso de Medicina da UFMG, utilizando um questionário online na plataforma Google Forms. RESULTADOS: Foram entrevistados 102 alunos. Nenhum deles tinha domínio sobre a língua e apenas 7% possuíam alguma habilidade. Desses, o que os motivaram a aprender Libras foi a proximidade com deficientes auditivos, o interesse em romper a barreira comunicativa entre profissionais de saúde e surdos ou a curiosidade. O meio utilizado para aprender Libras foi variado. Um quarto dos alunos não sabia da existência da disciplina optativa “Fundamentos de Libras” disponibilizada pela UFMG e, dentre os que sabiam, apenas três fizeram a disciplina. Para atender um deficiente auditivo, mais da metade dos alunos disseram que escreveria, desenharia e/ou faria mímicas, e 8 deles não saberiam o que fazer. Dentre os que possuem alguma habilidade na Libras, todos utilizariam a língua mesmo que de maneira limitada. Quase 80% dos entrevistados acreditam que é importante para a formação médica saber se comunicar com surdos por meio da Libras. CONCLUSÃO: Existe uma barreira comunicativa entre os estudantes de medicina recém-formados da UFMG e os surdos que utilizam a Libras. Tal estudo mostra, portanto, a noção da grandiosidade desse impasse, indicando a necessidade de iniciativas que preconizem pesquisas que possam divulgar as situações problemas e, posteriormente, tentar resolvê-las.INTRODUCTION: Curricular changes for Medical graduation includes the development of communication skills of the medical student. The knowledge of the Brazilian Sign Language (Libras) by the physician aims to break communicative barriers with deaf patients and is a good method to obtain qualified listening and excellence in health care. OBJECTIVE: To evaluate the contingent of doctors recently graduated from the Federal University of Minas Gerais (UFMG) who dominate Libras. METHODS: Interview applied to the students of the 12th period of the Medical School of UFMG, using an online questionnaire on the Google Forms platform. RESULTS: A total of 102 students were interviewed. None of them had mastery over the language and only 7% had some skill. Of those, what motivated them to learn Libras was the proximity to deaf people, the interest on breaking the communicative barrier between health professionals and the deaf or the curiosity. The way used to learn Libras was varied. A quarter of students did not know about the discipline “Fundamentals of the Brasilian Sign Language (Libras)” offered by UFMG and, among those who knew, only three of them took the discipline. In order to attend a deaf patient, more than half of the students said they would write, design, and/or mimic, and 8 of them did not know what they would do. Among those with some Libras ability, all would use the language even in a limited way. Almost 80% of the interviewed believe that it is important for the medical education to know how to communicate with the deaf through Libras. CONCLUSION: There is a communicative barrier between the doctors recently graduated from UFMG and deaf who use Libras. The study shows, a notion of the grandiosity of this impasse, indicating a need for initiatives that advocate research that reveal the problematic situations, and then, try to solve them

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Ano IX, número 19

Espaço e Economia: Revista Brasileira de Geografia Econômica, além dos artigos em fluxo contínuo, inclui nesta edição o Dossiê Oeste Metropolitano do Rio de Janeiro, organizado pelos professores Marcio Rufino Silva, Denise de Alcantara, Leandro Dias de Oliveira e André Santos da Rocha (PPGGEO e PPGDT-UFRRJ)