Posicionamiento oficial de Global Doctors for Choice Brazil (GDC): Para mantener los servicios de aborto legal en Brasil durante la pandemia

Últimamente se ha visto la suspensión de los servicios de aborto previstos por la legislación brasileña como un plan de contingencia ante la pandemia de COVID-19. Aunque estamos de acuerdo con la suspensión de los servicios no esenciales y cirugías electivas para canalizar las camas y los equipos de protección personal del sistema de salud al cuidado de personas infectadas con el coronavirus defendemos que se mantengan todos los servicios de aborto provistos por la legislación en Brasil (los pocos existentes) durante la crisis de salud que enfrentamos en este momento. Sugerimos al Ministerio de Salud para minimizar los riesgos lo siguiente: La aprobación del registro de la mifepristona por la Agencia Nacional de Vigilancia Sanitaria (ANVISA) y del aborto con medicamentos fuera del ambiente hospitalario. La regulación de la aspiración intrauterina manual como procedimiento ambulatorio. La regulación de salud a distancia/telesalud para los servicios de aborto legal en Brasil. La regulación del aborto quirúrgico en el segundo trimestre en lugares donde se encuentre un especialista capacitado para realizar el procedimiento y La conservación de los servicios de planificación familiar, especialmente para la inserción de dispositivos intrauterinos

Qualidade de vida relacionada à saúde e sintomas depressivos de estudantes do curso de graduação em Enfermagem

This is a descriptive, cross-sectional study aimed at investigating the health-related quality of life (HRQoL) of nursing students and its relationship with year of training, sociodemographic variables and the intensity of depressive symptoms. A convenience sample of 256 students, out of 353 eligible (72%), responded to the Medical Outcomes Study - The 36 Item Short-Form Health Survey (SF-36) and the Beck Depression Inventory (BDI) (self-administered). Final-year students, females and students with a higher intensity of depressive symptoms presented lower SF-36 scores in the physical functioning, vitality and social functioning domains. Institutional psychopedagogic support programs may minimize this negative impact on the HRQoL and encourage better professional performance of students in higher vulnerability situations.Se trata de un estudio descriptivo y transversal que investigó la calidad de vida relacionada a la salud (CVRS) de los estudiantes de enfermería y la relación con años de estudio, las variables sociodemográficas y la intensidad de los síntomas depresivos. Una muestra accidental de 256 estudiantes de 353 elegibles (72%) respondió el Medical Outcomes Study - The 36 Item Short-Form Health Survey (SF-36) y el Inventario de Depresión de Beck (IDB) (auto-aplicación). Estudiantes del último año del curso, los del sexo femenino y con mayor intensidad de síntomas depresivos, presentaron menores puntuaciones del SF-36 en los dominios capacidad funcional, vitalidad y aspectos sociales. El impacto es mayor en el último año del curso, los estudiantes de sexo femenino o con síntomas depresivos. Programas de apoyo psicológico podrían minimizar este impacto y contribuir a una mejor formación y desempeño profesional de los estudiantes en situación de mayor vulnerabilidad.Trata-se de estudo descritivo e transversal, que investigou a qualidade de vida relacionada à saúde (QVRS) de estudantes de Enfermagem e a relação da QVRS com o ano de estudo, as variáveis sociodemográficas e a intensidade de sintomas depressivos. Uma amostra acidental de 256 estudantes dos 353 elegíveis (72%) respondeu ao Medical Outcomes Study - The 36 Item Short-Form Health Survey (SF-36) e ao Inventário de Depressão de Beck (IDB). Estudantes do último ano do curso, sobretudo do sexo feminino e com maior intensidade de sintomas depressivos, apresentaram menores escores do SF-36 nos domínios capacidade funcional, vitalidade e aspectos sociais. O prejuízo na QVRS ocorre sobretudo no último ano do curso, nos estudantes do sexo feminino ou com sintomas depressivos. Programas institucionais de aconselhamento psicopedagógico poderiam minimizar o impacto negativo detectado na QVRS e contribuir para melhor formação e desempenho profissional dos estudantes em situação de maior vulnerabilidade

What do medical students think about their quality of life? A qualitative study

Abstract\ud \ud Background\ud Medical education can affect medical students’ physical and mental health as well as their quality of life. The aim of this study was to assess medical students’ perceptions of their quality of life and its relationship with medical education.\ud \ud \ud Methods\ud First- to sixth-year students from six Brazilian medical schools were interviewed using focus groups to explore what medical student’s lives are like, factors related to increases and decreases of their quality of life during medical school, and how they deal with the difficulties in their training.\ud \ud \ud Results\ud Students reported a variety of difficulties and crises during medical school. Factors that were reported to decrease their quality of life included competition, unprepared teachers, excessive activities, and medical school schedules that demanded exclusive dedication. Contact with pain, death and suffering and harsh social realities influence their quality of life, as well as frustrations with the program and insecurity regarding their professional future. The scarcity of time for studying, leisure activities, relationships, and rest was considered the main factor of influence. Among factors that increase quality of life are good teachers, classes with good didactic approaches, active learning methodologies, contact with patients, and efficient time management. Students also reported that meaningful relationships with family members, friends, or teachers increase their quality of life.\ud \ud \ud Conclusion\ud Quality of teachers, curricula, healthy lifestyles related to eating habits, sleep, and physical activity modify medical students’ quality of life. Lack of time due to medical school obligations was a major impact factor. Students affirm their quality of life is influenced by their medical school experiences, but they also reframe their difficulties, herein represented by their poor quality of life, understood as necessary and inherent to the process of becoming doctors

Medical students’ quality of life: does the learning environment matter?

Introdução: A qualidade de vida e a saúde mental dos estudantes de medicina podem afetar o seu desempenho acadêmico, suas habilidades e atitudes com pacientes. Evidências recentes confirmam a importância do ambiente educacional como um dos determinantes da saúde mental e qualidade de vida. Este estudo teve o objetivo de avaliar diferentes aspectos da qualidade de vida dos estudantes de medicina brasileiros em todos os anos do curso. Casuística e Métodos: Estudo transversal de abrangência nacional, com a utilização de questionário validado de qualidade de vida específico para o estudante da área da saúde (Veras-q). Resultados: De uma amostra aleatória de 1.650 estudantes, em 22 escolas médicas de diferentes regiões do país, 1.350 (81,8%) participaram do estudo. Os coeficientes de alfa Cronbach dos domínios do Veras-q variaram entre 0,77 e 0,82. Estudantes do sexo feminino apresentaram menores escores de qualidade de vida nos domínios físico, psicológico e uso do tempo, quando comparadas a seus colegas do sexo masculino (p<0,05; d<0,5). A percepção de qualidade de vida relacionada ao ambiente de ensino também foi menor entre estudantes dos últimos anos do curso (p<0,001; f<0,25), principalmente entre as mulheres (p<0,001; f=0,22). Conclusões: Estudantes do sexo feminino apresentaram pior percepção de qualidade de vida do que seus colegas do sexo masculino. Estudantes dos anos mais avançados do curso, principalmente as mulheres, apresentaram pior percepção de qualidade de vida no domínio ambiente de ensino quando comparados aos estudantes dos anos iniciais. Este estudo demonstra o impacto do ambiente educacional na qualidade de vida dos estudantes de Medicina e sugere que intervenções institucionais que aprimorem o ambiente, estimulem a formação de redes de suporte e promovam o bem-estar dos estudantes devem ser implementadas e avaliadas.Introduction: Medical students’ quality of life and mental health may affect their academic performance and their attitudes towards medical care. Recent evidence shows a preponderant role of the learning environment in the quality of life of medical students. This study aimed to assess Brazilian medical students’ quality of life throughout all years of medical school. Methods: Cross-sectional multi-centric study with the use of a quality of life questionnaire, validated for specific use among health sciences students (Veras-q). RESULTS: From a random sample of 1,650 students, 1,350 (81.8%) participated in the study. Cronbach’s alpha coefficients for Veras-q domains ranged from 0.77 to 0.82. Female students had lower scores on physical, psychological and time management domains of quality of life compared to male students (p<0.05; d<0.5). Perceptions of quality of life on the learning environment were also lower among students in the final years of medical school (p<0.001; f<0.25), especially among female students (p<0.001; f= 0.22). CONCLUSIONS: Female students showed worse perception of quality of life than their male counterparts. Students from more advanced years of medical school, especially women, also showed lower perception of quality of life in the learning environment domain. Institutional interventions directed to students at higher risk of low quality of life should be implemented and evaluated in further studies. This study demonstrates the impact of the learning environment on medical students’ quality of life, suggesting that institutional interventions designed to improve students’ well being such as the supporting networks must be adequately implemented and assessed

Empathy among medical students in Brazil: a multi-centric study

INTRODUÇÃO: A empatia representa um dos domínios centrais das habilidades sociais e de comunicação e é frequentemente associada a melhores resultados diagnósticos e terapêuticos. Por esse motivo, as habilidades empáticas dos profissionais da área da saúde têm sido amplamente investigadas no contexto da educação médica. Nosso objetivo foi avaliar a empatia do estudante de medicina e sua associação com qualidade de vida, esgotamento profissional e sonolência diurna. MÉTODOS: Estudo transversal randomizado de abrangência nacional, com a utilização de questionários de autorrelato validados para a avaliação de empatia (Escala Multidimensional de Reatividade Interpessoal de Davis - EMRI), qualidade de vida (The Whoqol Quality of Life Assessment - WHOQOL-BREF e Questionário para avaliar a qualidade de vida do estudante e residente da área da saúde - Veras-q), esgotamento profissional (Maslach Burnout Inventory - MBI) e sonolência diurna excessiva (Escala de Sonolência Diurna de Epworth - ESS) em uma plataforma eletrônica desenvolvida para o estudo - a plataforma VERAS. RESULTADOS: Dos 1.650 estudantes randomizados, 1.350 (81,8%) completaram todos os questionários da plataforma VERAS. Observamos importantes diferenças de gênero nos domínios consideração empática e angústia pessoal da EMRI, com maiores escores para o grupo do sexo feminino (p0,5). Estudantes dos diversos ciclos do curso de medicina apresentaram diferenças pouco expressivas das disposições empáticas (p0,8). Estudantes do sexo feminino apresentaram menores escores de qualidade de vida nos domínios físico, psicológico e uso do tempo (p0.5). Students from different phases of medical training had minor differences on empathic dispositions (p0.8). Female students had slightly lower scores on physical, psychological and time management domains of quality of life compared to male students (p<0.05; d<0.5). Perceptions of quality of life on the learning environment were also slightly lower among students in the final years of medical school (p<0.001; f<0.25). Female students had higher scores on emotional exhaustion and lower scores on depersonalization than their male counterparts (p<0.001; d<0.5). Students at the final years of medical school had slightly higher scores on emotional exhaustion, depersonalization and personal accomplishment (p<0.05; f<0.25). Daytime sleepiness scores were slightly higher among female students (p<0.001; d<0.5). Sleepiness scores did not differ according to phases of medical school. Approximately 56% of students had suggestive scores of excessive daytime sleepiness. Daytime sleepiness scores yielded weak correlations with empathy domains. Among male students, personal accomplishment (beta= -0.22; p<0.001) and psychological quality of life (beta= -0.19; p<0.001) contributed to lower personal distress. Among female students, personal accomplishment had a significant contribution to higher empathic concern (beta= 0.23: p<0.001) and perspective taking (beta= 0.30; p<0.001). Depersonalization scores contributed to lower empathic disposition on these domains (beta= -0.29: p<0.001 for empathic concern domain and beta= -0.17; p<0.001 for perspective taking domain). CONCLUSIONS: Female students had higher disposition on empathic concern and personal distress than their male counterparts. Differences on students\' empathic dispositions across phases of medical school were quite small. Among all study variables, personal accomplishment had higher contributions to lower personal distress among male students. Higher personal accomplishment and lower depersonalization also contributed to higher empathic disposition among female student

Health-related quality of life of medical students at the Federal University of Uberlândia

The need for curricular changes directed to the graduation of health professionals able to promote human&#8223;s health in its holistic meaning has stimulated great interest in medical students&#8223; mental health and health-related quality of life (HRQL). This study aimed at assessing the HRQL of medical students from the first to the sixth year of training through the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Students from the first to the sixth year of medical training at the Federal University of Uberlândia were asked to answer a sociodemographic questionnaire, the SF-36 and the Beck Depression Inventory (IDB) by self-application. Cronbach&#8223;s coefficient was calculated to determine the SF-36 reliability. Students and freshmen were compared according to demographics, SF-36 scores were compared according to the year in training, the presence of depressive symptoms, gender and the fact of living with or without relatives (Mann-Whitney or Kruskal-Wallis). SF-36 scores were also correlated to family income (Spearman coefficient). The effect size (ES) was calculated to determine the magnitude of the differences among groups and freshmen or first-year students. 352 students and 38 freshmen were enrolled in this study. Cronbach&#8223;s alpha varied form 0.66 to 0.89 to SF-36 domains. Freshmen&#8223;s mean age was 19.1 years (+ 1.9) and students&#8223; mean age was 22.3 (+ 2.42). Most of students were female (61.6%) and single (96.6%). Students had a prevalence of depressive symptoms of 36.3% whereas freshmen had a prevalence of 15.7% (p = 0.01). Scores from third and forth-year students were lower than freshmen and first-year students&#8223; scores in mental and physical domains (p 0.8) were detected in comparisons between third-year students and freshmen in global health, vitality and mental health. Students with depressive symptoms had lower scores in all domains and summary components of SF-36 when compared to students without depressive symptoms (p 0,8) foram encontrados na comparação do terceiro ano com os ingressantes nos domínios estado geral de saúde, vitalidade e saúde mental, Estudantes com sintomas depressivos obtiveram escores menores em todos os domínios e componentes do SF-36 em comparação com os estudantes sem sintomas depressivos (p< 0,01). Independentemente da presença de sintomas depressivos, os estudantes do segundo, terceiro e quarto anos tiveram prejuízo na QVRS em relação ao grupo de ingressantes e do primeiro ano no domínio vitalidade (p< 0,01). Estudantes do sexo feminino apresentaram escores menores em seis domínios e no componente mental do SF-36 em comparação com o sexo masculino (p< 0,01). As mulheres sem sintomas depressivos também apresentaram escores menores nos domínios capacidade funcional, dor e aspectos emocionais (p< 0,01). Concluiu-se que a transição do ciclo básico para o clínico (terceiro ano) - conforme o modelo curricular tradicional - representa uma fase de importante prejuízo na QVRS dos estudantes. Além disso, os estudantes com sintomas depressivos e do sexo feminino apresentam um maior impacto negativo na QVRS

Translation and cultural adaptation of the Pediatric Eosinophilic Esophagitis Symptom Score (PEESS v2.0)

Objectives: To translate and culturally adapt the Pediatric Eosinophilic Esophagitis Symptom Score (version 2.0), a tool used to assess pediatric eosinophilic esophagitis symptoms reported by patients and/or their parents/caregivers. Methods: The Pediatric Eosinophilic Esophagitis Symptom Score was translated through the following stages: initial translation, back-translation, and consensus of independent reviewers through the Delphi technique. The pre-final version of the Pediatric Eosinophilic Esophagitis Symptom Score was applied to five 8-to-18-year-old patients and to ten parents of two-to-18-year-old patients from an outpatient pediatric gastroenterology service (pre-test). Results: During the translation process, no translations presenting with difficult consensus in the review process or grammar inconsistencies were observed. During the pre-test, difficulties in comprehension of some unconventional terms, e.g., “náusea”, were observed. Adverbs of frequency, such as “quase nunca” were also identified as being of difficult understanding by patients and parents, and the substitution by the term “raramente” was suggested. Such difficulties may be inherent to the pediatric age group. Age 8 years or above should be considered adequate for the self-reporting of symptoms. Conclusions: The study presents the Brazilian version of the Pediatric Eosinophilic Esophagitis Symptom Score, which is adapted to the Brazilian culture. This version may be introduced as a clinical and research tool for the assessment of patients with esophagic disease symptoms. The Pediatric Eosinophilic Esophagitis Symptom Score is a breakthrough in the evaluation of symptoms of pediatric eosinophilic esophagitis, since it reinforces the importance of self-reporting by patients who experience this disease. Resumo: Objetivo: Traduzir e adaptar culturalmente a Pediatric Eosinophilic Esophagitis Symptom Score (versão 2.0), um instrumento usado para identificar os sintomas relatados pelos pacientes ou seus pais/responsáveis para a avaliação da esofagite eosinofílica pediátrica. Método: Realizamos o processo de tradução a partir da tradução inicial, retrotradução, seguida da etapa de obtenção de consenso por revisores independentes por meio da técnica Delphi. Aplicamos a versão pré-final a cinco pacientes de 8 a 18 anos e dez pais de pacientes de 2 a 18 anos, no Serviço de Gastroenterologia Pediátrica (pré-teste). Resultados: No processo de tradução, não encontramos traduções de difícil consenso no processo de revisão ou discordâncias gramaticais. No pré-teste, identificamos dificuldades de entendimento de termos pouco convencionais, como “náusea”, com sugestão de substituição para o termo “enjoo”. Outra dificuldade encontrada relacionou-se aos advérbios de frequência da escala, como, por exemplo, “quase nunca”, sendo sugerida a substituição pelo termo “raramente”. Essas dificuldades podem ser inerentes à faixa etária pediátrica. A idade dos pacientes a partir de oito anos deve ser considerada adequada para o uso de escores de autorrelato. Conclusões: A tradução do escore de sintomas da esofagite eosinofílica pediátrica produziu uma escala adaptada à cultura brasileira, que poderá ser introduzida como instrumento de investigação clínica e de pesquisa em pacientes com sintomas sugestivos de doenças esofágicas. É um importante avanço na avaliação dos sintomas, já que valoriza o relato dos próprios pacientes que convivem com essa doença. Keywords: Eosinophilic esophagitis, Translations, Self-report, Child, Adolescent, Palavras-chave: Esofagite eosinofílica, Traduções, Autorrelato, Criança, Adolescent