MEDICAL STUDENT IN THE FAMILY HEALTH STRATEGY ON THE FIRST YEARS OF COLLEGE: PERCEPTION OF GRADUATES

Considerando o desconhecimento do efetivo significado da vivência de estudantes de medicina ao serem inserido Estratégia Saúde da Família (ESF) em séries iniciais do curso por meio de estratégias de ensino baseadas na problematizaçao da realidade, propôs-se a compreender tal inserção na ótica dos egressos. Estudo qualitativo realizado por meio de entrevistas com egressos formados nos anos de 2009, 2010 e 2011. A análise dos dados teve como referência a técnica da hermenêutica-dialética. Os egressos consideram que essa inserção possibilitou o conhecimento da organização e funcionamento do serviço de saúde e do contexto de vida dos usuários, facilitou a relação médico paciente, o desenvolvimento do raciocínio clínico e o vínculo. Destacam, no entanto, que a imaturidade do estudante impede maior aproveitamento da vivência. Embora essa trajetória esteja permeada por avanços e desafios, conclui-se que ela se mostra capaz de sedimentar elementos imprescindíveis à formação médica.Considerando el desconocimiento del efectivo significado de la vivencia de estudiantes de medicina al ser inserido Estrategia Salud de la Familia (ESF) en series iniciales del curso por medio de estrategias de enseñanza basadas en la problematización de la realidad, se propuso a comprender tal inserción en la óptica de los egresos. Estudio cualitativo realizado por medio de entrevistas con egresos formados en los años de 2009, 2010 y 2011. El análisis de los datos tuvo como referencia la técnica de la hermenéutica-dialéctica. Los egresos consideran que esa inserción posibilitó el conocimiento de la organización y funcionamiento del servicio de salud y del contexto de vida de los usuarios, facilitó la relación médico paciente, el desarrollo del raciocinio clínico y el vínculo. Destacan, aunque, que la inmadurez del estudiante impide mayor aprovechamiento de la vivencia. Sin embargo esa trayectoria esté permeada por avances y desafíos, se concluye que ella se muestra capaz de sedimentar elementos imprescindibles a la formación médica.There is a lack of knowledge about the effective value of the experience gained by medical students who participate in the Family Health Strategy (Estratégia Saúde da Família (ESF)) during the early stages of their medical training. This teaching strategy is based on learning by experiencing the problems that exist in real life. This study proposed to understand the value of this teaching strategy from the viewpoint of the students who had participated, after their graduation. The method adopted was a qualitative study conducted through interviews with students who graduated in the years 2009, 2010 and 2011. The data analysis used the hermeneutic dialectic technique as its model. The graduates considered that this experience enabled them to understand the organization and functioning of the health service and the context of the daily life of the users. This experience facilitated the doctor patient relationship, the development of clinical reasoning and the bond with the user. However the students emphasized that a lack of maturity prevented them gaining a higher level of benefit from the experience. Therefore, although the structure of the course is permeated by advances and challenges, it was concluded that this experience contributed to the student's learning of certain essential elements of medical training

Programas de control externo de la calidad en serología desarrollados en América Latina con el apoyo de la OPS entre 1997 y 2000

OBJETIVOS: Con el apoyo de la Organización Panamericana de la Salud (OPS), desarrollamos entre 1997 y 2000 cinco programas de control externo de la calidad en serología (PCECS) en los que participaron entre 13 y 21 bancos de sangre de 11 a 16 países de América Latina. El objetivo fue evaluar el desempeño de los bancos de sangre con respecto al tamizaje serológico realizado en donantes de sangre. MÉTODOS: Como herramienta de trabajo utilizamos conjuntos de 24 muestras de sueros anónimos con reactividades variables para los parámetros de uso obligatorio en el tamizaje serológico de donantes de sangre en Brasil. En cada PCECS enviamos un multipanel a cada institución participante para que lo procesara en las mismas condiciones de su rutina de tamizaje. Cada participante recibió la clave del multipanel para autoevaluación, después de haber devuelto los resultados obtenidos en su laboratorio. Se mantuvo siempre la más estricta confidencialidad sobre los resultados obtenidos individualmente. Al terminar de cada programa, el Centro Organizador (Superintendencia de Serología de la Fundação Pró-Sangue/Hemocentro de São Paulo) elaboró un informe final que contenía toda la información obtenida en el programa y que fue enviado a los participantes. RESULTADOS: En el análisis de los cinco PCECS se observó falta de homogeneidad entre los países con respecto a las estrategias y a los parámetros utilizados en el tamizaje de donantes de sangre. Pocos laboratorios practicaron el tamizaje de los virus linfotrópico de células T humanas (HTLV) (17%, 27%, 35%, 39% y 45%, respectivamente y en orden creciente para los cinco PCECS) y de anticuerpos contra el antígeno nuclear del virus de la hepatitis B (anti-HBc) (42%, 27%, 39%, 50% y 60%). También se observaron diferencias importantes en cuanto a las pruebas o combinaciones de pruebas utilizadas, lo cual puede dificultar el estudio comparativo de los tipos de tamizaje. El número total de resultados positivos falsos osciló alrededor del 2%, correspondiendo el mayor valor al tamizaje de anticuerpos contra el virus de la hepatatis C (anti-VHC) (4,6%) y el menor a anti-Trypanosoma cruzi (0,4%). CONCLUSIONES: Los resultados obtenidos en este trabajo demuestran la necesidad de continuar las acciones de la OPS en América Latina para reforzar los procedimientos de tamizaje serológico en bancos de sangre, incluso los PCECS, hasta que se consiga una uniformidad de procedimientos en la Región de las Américas

Evaluation of the concomitant use of two different EIA tests for HIV screening in blood banks

OBJECTIVE: In 1998, the Brazilian Ministry of Health made it mandatory for all blood banks in the country to screen donated blood for human immunodeficiency virus (HIV) concomitantly using two different enzyme immunoassay (EIA) tests. Concerned with the best use of available resources, our objective with this study was to evaluate the usefulness of conducting two EIA screening tests instead of just one. METHODS: We analyzed data from 1999 through 2001 obtained by testing 698 191 units of donated blood using two EIA HIV screening tests concomitantly at the Pro-Blood Foundation/Blood Center of São Paulo (Fundação Pró-Sangue/Hemocentro de São Paulo), which is a major blood center in the city of São Paulo, Brazil. All samples reactive in at least one of the two EIA tests were submitted for confirmation by a Western blot (WB) test, and the persons who had donated those samples were also asked to return and provide a follow-up sample. RESULTS: Out of the 698 191 blood units that were donated, 2 718 of them (0.4%) had to be discarded because they were reactive to at least one of the EIA tests. There were two WB-positive donation samples that were reactive in only one HIV EIA screening test. On their follow-up samples, both donors tested WB-negative. These cases were considered false positive results at screening. Of the 2 718 donors who were asked to return and provide a follow-up sample, 1 576 of them (58%) did so. From these 1 576 persons, we found that there were two individuals who had been reactive to only one of the two EIA screening tests and who had also been negative on the WB at screening but who were fully seroconverted on the follow-up sample. We thus estimated that, in comparison to the use of a single EIA screening test, the use of two EIA screening tests would detect only one extra sample out of 410 700 units of blood. CONCLUSIONS: Our data do not support the use of two different, concomitant EIA screening tests for HIV. The great majority of HIV-positive donors have already seroconverted and will be detected using only a single EIA screening test. Only persons who are going through the process of seroconversion may be missed by using a single EIA test and detected using two EIAs for screening. To screen out these individuals and decrease the residual risk of HIV transmission from the blood donated in our center, the use of other techniques, such as nucleic acid testing (NAT) or a p24 antigen assay, would be more effective

External quality control program in infectious diseases screening at laboratories and blood banks in Latin America: an analysis of the past 5 years

Objective. To evaluate the screening of blood samples for infectious disease markers at laboratories and blood banks in Latin America per the findings of an External Quality Assessment Program (EQAP). Methods. This qualitative analysis used data from the EQAP coordinated by the Fundação Pro Sangue Hemocentro de São Paulo with the support of the Pan American Health Organization to assess the performance of blood screening for infectious diseases from 2014 to 2018 in Latin America. Each participating laboratory or blood bank received an identical blind panel with 24 blood samples with variable reactivity for all the screening parameters. Panels were processed at each participating facility and results were returned to the Fundação Pro Sangue Hemocentro de São Paulo for individual and joint analyses. Two types of discrepant results were potential failures: false positive results (FPRs) and false nonreactive results (FNRRs). Results. A total of 23 136 samples were evaluated. Global rates of FPR, FNRR, and concordant results were 0.3%, 1.0% and 98.7%, respectively. Seven FNRRs were found for HBsAg (1.0%), 12 for syphilis (2.6%), and 21 for Chagas disease (2.9%). No FNRRs were found for the HIV, HCV, and HTLV viruses. The average accuracy of all the laboratories and blood banks participating in the EQAP during the study period was 99.5% (standard deviation, 0.5%). Conclusion. The findings of this qualitative analysis are positive for blood safety in Latin America, with an average accuracy of 99.5% among the participating laboratories and blood banks. This report reflects an important improvement in blood bank serological screening EQAP-PAHO report since the 2003

Descarte de bolsas de sangue e prevalência de doenças infecciosas em doadores de sangue da Fundação Pró-Sangue/Hemocentro de São Paulo

OBJETIVO: Analisar a evolução, de 1991 a 2001, do descarte sorológico na Fundação Pró-Sangue/Hemocentro de São Paulo, o maior banco de sangue da América Latina, e verificar a prevalência de doenças infecciosas entre doadores dessa instituição no ano de 2001. MÉTODOS: Foram compilados os dados de descarte sorológico relativos aos anos de 1991 a 2001. Para determinar a prevalência de doenças infecciosas, foram analisadas 9 942 amostras triadas em novembro de 2001, sendo as amostras reativas submetidas a testes confirmatórios. RESULTADOS: Foi encontrada uma diminuição percentual significativa de descarte, de 20% em 1991 para 9% em 2001. A prevalência de doenças infecciosas entre doadores em 2001 foi de 0,04% para vírus da imunodeficiência humana (VIH); 0,21% para vírus da hepatite C (VHC); 0,06% para vírus T-linfotrópico humano (HTLV); para vírus da hepatite B (VHB), as prevalências foram de 0,14% para anti-HBc + HBsAg, 1,68% para anti-HBc + anti-HBs e 1,67% para anti-HBc isolado; 1,10% para sífilis; e 0,14% para doença de Chagas. CONCLUSÃO: A diminuição no descarte e a prevalência de doenças infecciosas entre doadores da Fundação Pró-Sangue/Hemocentro de São Paulo em 2001 refletem o aumento na porcentagem de doadores de repetição nesse banco de sangue

WHO comparative evaluation of serologic assays for Chagas disease

Evaluation of commercially available test kits for Chagas disease for use in blood bank screening is difficult due to a lack of large and well-characterized specimen panels. This study presents a collaborative effort of Latin American blood centers and the World Health Organization (WHO) to establish such a panel. A total of 437 specimens, from 10 countries were collected and sent to the WHO Collaborating Center in Sao Paulo and used to evaluate 19 screening assays during 2001 through 2005. Specimens were assigned a positive or negative status based on concordant results in at least three of the four confirmatory assays (indirect immunofluorescence, Western blot, radioimmunoprecipitation assay, and recombinant immunoblot). Of the 437 specimens, 168 (39%) were characterized as positive, 262 (61%) were characterized as negative, and 7 (2%) were judged inconclusive and excluded from the analysis. Sensitivity and specificity varied considerably: 88 to 100 and 60 to 100 percent, respectively. Overall, enzyme immunoassays (EIAs) performed better than the other screening assays. Four EIAs had both parameters higher than 99 percent. Of the four confirmatory assays, only the RIPA gave a 100 percent agreement with the final serologic status of the specimens. The sensitivities and specificities of at least four of the commercially available EIAs for Chagas disease are probably high enough to justify their use for single-assay screening of blood donations. Our data suggest that the majority of commercially available indirect hemagglutination assays should not be used for blood donor screening and that the RIPA could be considered a gold standard for evaluating the performance of other assays.Mauricio Beltran Duran (Instituto Nacional de Salud, Colombia)Marco Antonio Heroiza Holgin (Secretario Nacional de Bancos de Sangre, Ecuador)Graciela Velasquez (Universidad Nacional de Asuncion, Instituto de Investigaciones en Ciencias de la Salud, Paraguay)Elizabeth Vinelli (Cruz Roja Hondurena, Honduras)Ana del Pozo (Hospital de Pediatria ""Prof. Dr Juan P. Garrahan,"" Argentina)Maria del Carmen Zambraba M. (Banco de Sangre Regional de Cochabamba, Bolivia)Antonio Marin y Lopez (Centro Nacional de Transfusion Sanguinea, Mexico)Graciela Echegoyen de Hernandez (Cruz Roja Salvadorena, El Salvador)RenE Berrios Cruz (Cruz Roja Nicaraguense, Nicaragua