Sobre o ensino das literaturas africanas lusófonas na formação inicial docente: uma estratégia com os círculos de leitura a partir de terra sonâmbula, de Mia Couto.

A aprovação da Lei 10.639/03-MEC torna obrigatório o ensino da história e da cultura afro-brasileira e africana em todas as escolas públicas e particulares, do ensino fundamental até o médio. A inserção das literaturas africanas lusófonas nas salas de aula do Brasil é ponto de partida para o envolvimento dos sujeitos em formação em um contexto que deve estimular a noção de diversidade cultural (NÓBREGA, 2014). Esta pesquisa envereda pelos limites dos estudos literários póscoloniais atrelados às reflexões acerca do ensino das literaturas africanas lusófonas. A partir de seu caráter interventivo, por se tratar de uma pesquisa-ação, buscou-se como principal objetivo: Refletir acerca das abordagens das Literaturas africanas lusófonas na formação inicial de graduandos em Letras da UFCG, a partir da obra Terra sonâmbula, de Mia Couto, visando desenvolver uma prática metodológica com Círculos de Leitura (COSSON, 2014) que aponte para a ampliação do repertório de leituras no aprimoramento dos saberes docentes. Nessa perspectiva, a abordagem de um romance moçambicano pela metodologia dos Círculos de Leitura pode proporcionar ao leitor uma experiência estética relevante em que os registros subjetivos se fundamentem na construção de diários de leitura. Os resultados desse olhar acerca da realidade estão categorizados a partir das experiências de leitura subjetivas registradas nos diários (ROUXEL, 2014). Por esse prisma, torna-se relevante a consideração da formação do docente como mediador diante dos enfrentamentos entre sujeitos nas salas de aula. Essas reflexões estão baseadas nas teorias de HALL, 2013; 2014; BONNICI, 2013; LEITE, 2013; BHABHA, 2013; SAID, 2011; FOUCAULT, 2014; RIOS, 2007; entre outros.The approval of Law 10.639 / 03-MEC, makes it mandatory the teaching of history and African-Brazilian and African culture in all public and private schools, from elementary school through high school. The inclusion of Lusophone African literatures in the classrooms of Brazil is the starting point for the involvement of subjects in training in a context that should stimulate the notion of cultural diversity (NÓBREGA, 2014). This research goes through the limits of postcolonial literary studies linked to reflections on the teaching of Lusophone African literatures. From its interventionist character, because it is an action research, we sought to the main objective: To reflect on the approaches of Lusophone African Literatures in initial training of graduate students in Arts UFCG, from Earth sle epwalker work of Mia Couto, aiming to develop a methodological practice with Reading Circles (COSSON, 2014) that aims to expand the repertoire of readings in the improvement of teaching knowledge. In this perspective, the approach of a Mozambican novel by the Reading Circles methodology can provide the reader with an important aesthetic experience in which subjective records were based on the construction of reading daily. The results of this look about reality are categorized from subjective reading experiences recorded in diaries (ROUXEL, 2014). From this perspective, it is relevant to consider the teacher formation as a mediator before the confrontation between subjects in the classroom. These reflections are based on the theories of HALL, 2013; 2014; BONNICI, 2013; LEITE, 2013; BHABHA, 2013; SAID, 2011; FOUCAULT, 2014; RIOS, 2007; among others.Cape

Carta ao Editor a Propósito do Artigo: “Prescrição Inapropriada em Idosos numa Enfermaria de Medicina Interna”

Dear Editor, We read with interest an article about inappropriate prescribing to elderly patients in an internal medicine ward and a letter to the editor regarding the same paper. We developed a similar study in the Portuguese primary care setting with a nation-wide representative sample of 757 elderly patients in accordance to its distribution in Portuguese health regions and we found that 77% of them were on ≥ 5 medications (with a mean of 8.2) and that 68% had at least one potentially inappropriate medication according the to 2015 Beers Criteria (with a mean of 1.72). The most common potentially inappropriate pharmacological classes were proton pump inhibitors (45.6%), non-steroid anti-inflammatory agents (34.5%) and benzodiazepines (27.3%). As such, we were also surprised with the low proportion of inappropriate prescribing at admission and at discharge reported in the study. One of the explanations, that was already reported, is the restricted number of pharmacologica classes used. This does raise many questions. Are we managing the various problems of our population in the best way? Is it necessary to rethink the polypharmacy cut-off since with the aging of the population there is an increase in the number of chronic diseases and consequently an increase in the number of drugs necessary to control them? Do we have to practice according to the guidelines or according to our clinical judgement of pathophysiology? Does this defnition of fve drugs for polypharmacy put people at a higher risk of undermedication, instead of overmedication?5 Shouldn’t we think of a new defnition for polypharmacy that isn’t the same for all people, but which takes into account the burden of disease that it is subject to? E.g. does it make sense to use the same polypharmacy cut-off for a healthy individual and a post-myocardial infarction patient? We consider this issue as fundamental, since as already mentioned the management of multimorbidity and polypharmacy (more specifcally of potentially inappropriate medication) are essential pillars in the provision of health care nowadays, both in primary and secondary care. So this raises the question of time since, in medical education, when should this topic be addressed and by whom? It is also important to analyze if there are differences between the work at the different health care levels regarding the management of multimorbidity, polymedication and potentially inappropriate medication. Are we all working towards the same goal?info:eu-repo/semantics/publishedVersio

Prevalence of polypharmacy in the older adult population within primary care in Portugal: a nationwide cross-sectional study

Introduction Polypharmacy is commonly defined as the simultaneous use of five or more medications; however, there is a lack of consensus regarding the most appropriate definition. It is a significant predictor of morbidity and mortality. The aim of this study was to determine the prevalence of polypharmacy in the population of older adults attending primary care in Portugal and to identify associated sociodemographic and clinical factors. Material and methods We conducted a cross-sectional, analytical study in primary care centres from the five Portuguese healthcare administrative regions and the two autonomous regions. We used a random sample of 757 older adult patients provided by the information department of the ministry of health (SPMS) and family doctors from the autonomous regions. Data collection occurred in March 2018. The variables utilised were sociodemographic characteristics, clinical profile and medication. For each patient, polypharmacy was measured either by the concurrent use of ≥ 5 drugs or by the median number of drugs at the time of data collection. Logistic regression analyses were performed to determine associations between polypharmacy and other variables. Results Polypharmacy (≥ 5 drugs) was present in 77% of the sample. A cut-off of over the median number of drugs was present in 55%. The likelihood of having polypharmacy increased significantly with age (OR = 1.05 (1.02–1.08)), number of chronic health problems (OR = 1.24 (1.07–1.45)) and number of prescribers (OR = 4.71 (3.42–6.48)). Cardiovascular, metabolic and musculoskeletal medications were the most commonly involved in polypharmacy. Conclusions Polypharmacy was a very common occurrence in Portugal. Future primary healthcare policies should address polypharmacy.info:eu-repo/semantics/acceptedVersio

A PROPRIEDADE DA TERRA E A QUESTÃO AGRÁRIA BRASILEIRA

A propriedade privada é algo construído conscientemente pelo homem. A consolidação da apropriação privada dos bens é uma particularidade histórica; desenvolve-se na Europa principalmente nos séculos XIV e XV. O direito moderno serviu como instituto para que a apropriação dos bens pudesse se universalizar, trazendo como natural o direito de propriedade, garantindo a legitimidade de um sistema em benefício de poucos. Os novos posicionamentos culminaram na consolidação da propriedade individual afirmada como liberdade do sujeito, a exemplo do Código de Napoleão, o que gerou um processo de exclusão. No Brasil não foi diferente. A necessidade foi de terras para o cultivo do açúcar. A Constituição Federal de 1988 passou a garantir a propriedade que atenda sua função social, considerando valores que integram os interesses da coletividade, bem como a dignidade humana. No entanto, tem-se como questão central do problema agrário brasileiro os conflitos possessórios, entre os proprietários dos latifúndios, que não atendem sua função social, e os trabalhadores rurais sem terra

The impact on health-related quality of life of mixed mental and physical multimorbidity in adults aged 60 years and older: secondary analysis of primary care data

Introduction Given the number of patients with mental conditions who receive treatment within the primary care (PC) context, and the high prevalence of multimorbidity (especially in older people), there is a need to study mental-physical multimorbidity (MPM) in this population and context. This study sought to identify the impact on health-related quality of life (QoL) of MPM in adults aged 60 years and older. Material and methods Secondary analysis of data derived from 251 primary health individuals. Data were collected via a sociodemographic and clinical questionnaire. Health-related QoL was assessed using the SF-12 instrument. Multiple linear regressions were performed for physical and mental health in MPM patients and in patients with physical-only multimorbidity. Results Mean age of participants was 70.6 years; 57.8% were female. Quali¬ty of life was lower in MPM patients than in those with physical-only multimorbidity. Regarding MPM patients, female sex, 75 years and over, and low income were associated with worse physical health. Female sex was also associated with worse mental health. Conclusions This study contributes to the global knowledge of MPM in older people, illuminates health-related QoL differences among MPM and physical- only multimorbidity patients, and highlights the importance of non-modi-fiable characteristics associated with deterioration of health-related QoL. Team collaboration between primary care physicians, psychiatrists (and other mental health providers), and social workers may be necessary to assess psychiatric and physical symptoms and provide for the care needs of older people with MPM.info:eu-repo/semantics/acceptedVersio

Prevalence of chronic obstructive pulmonary disease in general practice patients in the Central Region of Portugal

Introduction COPD is a common worldwide condition associated with morbidity and mortality. Its symptoms can be easily overlooked, accounting for an elevated level of under-recognition and under-diagnosis. Knowledge of the prevalence of COPD and the significance of its associated factors in the population enables better management of medical resources. To establish the prevalence of COPD in General Practice patients in the Central Region of Portugal and analyze the correlation with associated factors. Material and methods Cross-sectional study of patients’ data with COPD (R95, International Classification for Primary Care 2), anonymously gathered from the official database of the Central Health Administration of Portugal. Results Out of 937,817 individuals, 24,148 patients were identified with COPD, a prevalence of 2.57/100,000. 73.7% were above 65 years of age, and 60.2% were males. BMI was recorded in 60.2% patients, FEV1(%) in 8.0%, and smoking pack-years in 37.1%. Age and BMI were significantly negatively correlated (ρ = -0.032, p < 0.001), with the same occurring between age and FEV1(%) (ρ = -0.073, p < 0.05). A strong association of COPD with male gender and older age groups was found. Conclusions The prevalence of COPD was significantly higher in males, and age was identified as a risk factor for this condition. Higher age was non-significantly associated with lower FEV1(%) and significantly associated with BMI. The lack of e-records calls for an improvement.info:eu-repo/semantics/publishedVersio

Defining Multimorbidity: From English to Portuguese Using a Delphi Technique

Objective. To translate the EuropeanGeneral Practice ResearchNetworkmultimorbidity definition according to Portuguese cultural and linguistic features. Methods. Similar to the process completed in several other European countries, a forward and backward translation of the English multimorbidity definition using the Delphi technique was performed in Portugal. Results. Twenty-three general practitioners (GPs)—14 males and 9 females—agreed to form the Portuguese expert panel for the Delphi process (59% acceptance rate).The Portuguese definition of multimorbidity was achieved after two Delphi rounds with a mean (SD) consensus score for final round of 8.43/9 (0.73). Conclusion. With this paper the definition of multimorbidity is now available in a new language—Portuguese. Its availability in the local language will raise Portuguese GPs’ awareness about multimorbidity and allow future national and international research. The operationalization of the definition will allow an easier identification of patients with multimorbidity.info:eu-repo/semantics/publishedVersio

Patients’ and tutors’ evaluations of medicine students’ consultations in general practice/family medicine in Coimbra

Background Undergraduate teaching of General Practice/Family Medicine (GP/FM) must ensure students acquire the necessary competencies and skills to perform an adequate GP/FM consultation with adequate annotations (the SOAP model) and classifications. So aimed to study and to correlate students’ evaluation by tutors and patients in specific consultations in the formal practical evaluation of GP/FM Curricular Unit of the Integrated Masters on Medicine at the Faculty of Medicine of the University of Coimbra (IMM-FMUC) in the academic years of 2017–2018 and 2018–2019. Methods Observational study of the 2017–2018 and 2018–2019 academic years of the assessment grids for tutor’s evaluation of SOAP performance and fluency in consultation and for patient’s evaluation of the student ‘performance, in the convenience sample of those who chose to be so evaluated. Results We studied a population of 435 (67,7%) out of a universe of 646 students, 125 (28,7%) males, ns by sex and academic year who performed this evaluation. In a mark up to 20 from tutors, difference was found for Plan (P) mark, higher in 2018–2019 (18,38 ± 2,18vs18,54 ± 2,11, p = 0,005) of the SOAP methodology evaluation. Patients’ evaluation was not different 19,34 ± 1,70vs19,35 ± 1,40, p = 0,091. A positive significant correlation was found between tutors and patients marks (ρ = 0,278; p < 0,001), as well as between tutor mark and final mark (ρ = 0,958; p < 0,001) and patient and final marks (ρ = 0,465; p < 0,001). Final marks were not different in both years, 18,61 ± 1,38vs18,78 ± 1,15, p = 0,158. Conclusions This innovative model of evaluation of student’s performance in medical appointment, showed a significant positive moderate correlation between patients’ and tutors’ marks in the setting of GP/FM at the IMM-FMUC, and was not different between years. Yearly evaluation must be continued.info:eu-repo/semantics/publishedVersio