Impacto do Confinamento em Crianças e Adolescentes

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Práticas artísticas no ensino básico e secundário

O terceiro número da Revista Matéria-Prima afirma-se como mais uma plataforma de disseminação e de registo na área da educação e ensino artísticos. Ao propor-se o desafio da Matéria-Prima está a lançar-se um repto de intervenção e partilha a três tipos de intervenientes na educação pela arte: — Os professores, profissionais experimentados; — Os que se iniciam na profissão, através da frequência de mestrados e estágios formativos; — Os investigadores e professores universitários desta área. Esta chamada coloca em cima da mesa a partilha das experiências didácticas em sala de aula, a pesquisa sobre práticas profissionais. Experiências, algumas bem-sucedidas, outras menos, porventura, todas com um mérito substancial, que é a vontade de estabelecer comunidade entre os interessados pela educação artística. Este conjunto de textos poderá ajudar a cartografar práticas que se observam bastante distintas, entre as realidades dos países representados, Portugal, Espanha, Brasil, Argentina. Observa-se também que a prática dos educadores está longe de ser homogénea. É surpreendente determinar as diferenças entre contextos e regiões. Se umas são mais metódicas, e por isso consistentes, outras abrem-se à descoberta. Em todas um ponto de encontro: a revista Matéria-Prima, que assim assume cada vez mais o seu nome como um desígnio de intervenção.info:eu-repo/semantics/publishedVersio

Medicina centrada no paciente e capacitação do consulente em medicina geral e familiar

Introdução: A Medicina Centrada no Paciente (MCP) abrange a experiência total de doença do utente, envolvendo-o nas decisões clínicas. Não existe em Portugal uma ferramenta que avalie a sua existência segundo a opinião do consulente. A Capacitação representa a medida em que um paciente se sente fortalecido, após uma consulta médica, na compreensão e gestão da doença. O Instrumento de Capacitação do Consulente (PEI/ICC) foi validado recentemente para a população portuguesa. Objetivos: São objetivos deste estudo a validação do Questionário da MCP em Portugal (MCP-PT), e a verificação da existência de MCP conforme a opinião do consulente, relacionando-a com a Capacitação, segundo o PEI/ICC. Materiais e Métodos: Construímos o MCP-PT com base nos seis componentes da MCP propostos por Moira Stewart e validámos em trinta consulentes da USF Topázio. De seguida, aplicámos o MCP-PT e o PEI/ICC, em duzentos utentes das USF Topázio, Briosa e Rainha Santa. Analisámos as respostas segundo o género, grupo etário, tipo de família, grau de formação, ter doença crónica e tomar medicamentos regularmente. Posteriormente, verificámos a correlação entre os dois questionários. Resultados: O MCP-PT foi validado para Portugal com valores de Alfa de Cronbach superiores a 0,8 e excelente fiabilidade. A amostra inquirida é maioritariamente feminina, entre 36 e 64 anos, vive acompanhada, tem a 4ª classe e toma medicamentos regularmente, referindo 50% ter doença crónica. A distribuição das respostas no MCP-PT teve propensão para a resposta “Sim” e, no PEI/ICC, a resposta intermédia “Melhor” foi tendencialmente mais escolhida. O MCP-PT, sendo um indicador composto por vários objetivos, foi estudado em valor absoluto e em distribuição relativa a valores percentílicos. O PEI/ICC tem também valor de indicador que estudámos igualmente. Verificámos correlação entre o MCP-PT e o PEI/ICC, que variam em sentido oposto de valor, com p=0,010. Discussão e Conclusão: Neste estudo, pudemos validar o MCP-PT para a população portuguesa, aferindo a opinião do consulente sobre a aplicação da MCP na consulta. A verificação de correlação positiva entre a MCP e a Capacitação, permite pensar em melhores resultados terapêuticos. Salientamos a necessidade de se realizarem mais estudos nesta área, com amostras mais significativas e noutras regiões de Portugal.Introduction: The Patient-Centered Medicine (PCM) embraces the total experience of the patient's disease, involving him in the clinical decisions. In Portugal, there is not a questionnaire to assess its existence based on patients’ opinion. Enablement is the way the patient feels and how he deals with the disease himself after a doctor's appointment. The Patient Enablement Instrument (PEI/ICC) was recently validated for the Portuguese population. Objectives: To validate the questionnaire of PCM in Portugal (PCM-PT), in order to get the patients’ opinion about the existence of the PCM, and to co-relate it to the Enablement, according to the PEI/ICC. Materials and Methods: We built the PCM-PT based on the six components of the PCM proposed by Moira Stewart and validated it in a thirty consultants of Topázio Family Health Unit (FHU) sample. Then, we applied the MCP-PT and the PEI / ICC to two hundred users of Topázio, Briosa and Rainha Santa FHU. We analyzed the responses considering gender, age group, family type, academic qualifications, auto-perception of sufferance of chronic disease and being regularly on medicines. Later, correlation between these two questionnaires was studied. Results: The PCM-PT was validated for Portugal with Alpha Cronbach values above 0.8. The sample was mostly formed by 36 to 64 year-old-women, not living alone, with a four-year school degree and taking medications regularly. Half of them had some kind of chronic disease. Most of the answers, in what concerns the PCM-PT, were positive – “Yes”. In the PEI / ICC questionnaire, the intermediate option "Better" was the most frequent. Being an indicator with multiple objectives, the MCP-PT was studied in absolute value and percentile distribution. We also studied the indicator value of the PEI/ICC. Finally, we found the correlation between these two questionnaires, which vary in the opposite direction, and we obtained a p-value = 0,010. Discussion and Conclusion: In this study, we validated the PCM-PT for the portuguese population, based on the patients’ opinion on what concerns the implementation of PCM Later, we found a positive correlation between the PCM and the Enablement, which can mean better appointment and health outcomes. We believe that more studies are necessary on this theme, that is to say, with bigger samples and in further Portuguese regions

Ácido fólico, vitamina B12 e sintomas psicóticos no internamento psiquiátrico de crianças e jovens

Introduction: Folic acid and/or vitamin B12 deficiency are known to be associated with neuropsychiatric disorders. However, the association between serum levels of these molecules and psychotic symptoms is not established. The aim of this study was to investigate the association between folic acid and vitamin B12 serum levels and the presence of psychotic symptoms among child and young adult psychiatric inpatients. Material and Methods: This was a retrospective cohort study of 165 patients under 25 years of age admitted due to psychiatric disorders between 2005 and 2018 and with folic acid and vitamin B12 serum levels assessed during hospitalization. Two groups of patients were defined according to presence or absence of psychotic symptoms. Rehospitalization was also assessed. Results: Folic acid serum levels were significantly lower (p=0.01) in children and young adults hospitalized for psychiatric disorders with psychotic symptoms compared to patients of the same age with acute psychiatric illness without psychotic symptoms. A similar non-significant trend was found for vitamin B12. Rehospitalization rates were also higher in the first group. Conclusion: Results from this study suggest that low folic acid serum levels are associated with psychotic symptoms regardless of the baseline diagnosis.info:eu-repo/semantics/publishedVersio

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status