The critical dialogical method in Educommunication to develop narrative thinking

En la conceptualización de la Educomunicación se ha de avanzar hacia la integración de sus dos grandes perspectivas. Fomentar el diálogo crítico es un objetivo compartido por ambas, por lo que es preciso profundizar en sus propiedades, métodos y funciones educativas. Se presenta un modelo formativo en educomunicación que ha sido testado mediante una investigación empírica. Durante dos semanas, 246 niños entre seis y once años asisten a sesiones formativas con dos tipos de productos audiovisuales. La mitad de los niños sigue un proceso formativo según la metodología dialógicocrítica y la otra mitad una metodología de diálogo-conversacional. Los resultados muestran que los niños que siguen la formación dialógico-crítica se benefician significativamente en la construcción de su competencia mediática y pensamiento narrativo, en comparación con los niños de los grupos dialógico-conversacional. Los resultados revelan también que no todos los tipos de contenidos audiovisuales son beneficiosos para la formación del pensamiento del niño. Esta investigación pone de manifiesto cuáles son las propiedades del método dialógico-crítico propuesto que permiten al niño mejorar su competencia mediática e ilustra la complementariedad entre el proceso de diagnóstico-estático de competencias y el proceso formativo-dinámico que conduce al pensamiento crítico. Desde un punto de vista aplicado, este método ha mostrado su utilidad para ser utilizado por el profesor para fomentar en su grupo de alumnos una educación mediática que contribuya al desarrollo del pensamiento narrativoIn the conceptualization of Educommunication, progress must be made towards the integration of its two great perspectives. Encouraging critical dialogue is a goal shared by both, so it is necessary to delve into its educational properties, methods and functions. A training model in Educommunication that has been tested through empirical research is presented. For two weeks, 246 children between six and eleven years old, attended training sessions with two types of audiovisual products. Half of the children were involved in a training process using critical dialogical methodology, whereas the training process for the other half of the children followed conversational dialogue methodology. The results show that children who follow the critical dialogical training benefit significantly in the construction of their media competence and narrative thinking, compared to the children of the conversational dialogical groups. The results also reveal that not all types of audiovisual content are beneficial to the construction of children's thinking. This research reveals the properties of the proposed critical dialogical method that allows children to improve their media competence and illustrates the complementarity between the diagnostic-static process of competences and the formative-dynamic process that leads to critical thinking. From an applied point of view, the critical dialogical method has been useful for use by teachers to foster a media education in their group of students that contributes to the development of narrative thinkin

Inflammation, Diabetes, and Chronic Kidney Disease: Role of Aerobic Capacity

The persistent inflammatory state is common in diabetes and chronic kidney disease (CKD). These patients present exercise intolerance and increased arterial stiffness. Long-term aerobic exercise has been associated with better arterial compliance, antidiabetic and antiinflammatory benefits. We assessed the hypothesis that in patients with diabetes and CKD, better aerobic capacity is associated with less inflammatory state and arterial stiffness. Thirty-nine CKD patients (17 in hemodialysis) were evaluated. According to CKD etiology two patient groups were obtained: group of diabetics (GD) was formed by 11 patients and nondiabetics (GND) formed by 28 patients. Central blood pressure and arterial stiffness were evaluated by Sphygmocor device. Carotida intima-media thickness (CA-IMT) was evaluated by ultrasonography. Aerobic capacity was measured by estimated VO2max according to treadmill test by Bruce protocol. The GD showed a higher frequency of C-reactive protein above laboratory cutoff (P = 0.044), higher frequency of male gender, and a non significant higher value of VO2max (P = 0.099). The CA-IMT was similar. Only better aerobic capacity was associated with lower frequency of high C-reactive protein when adjusted to diabetes and gender in a logistic regression model. In conclusion, aerobic capacity was associated with inflammatory state, in CKD patients, independently of diabetes presence

Reflexões das ações de engajamento estudantil no processo de construção da avaliação de um curso

INTRODUÇÃO: A avaliação Institucional pode diagnosticar tendências e desalinhamento de seus objetivos, conhecendo e reconhecendo suas fortalezas e fraquezas. Assim, correlaciona-se com a melhoria da qualidade da formação e, portanto, do profissional egresso. A participação discente na elaboração desse processo é imprescindível, para que a avaliação se consolide como democrática e representativa. OBJETIVO: Apresentar a experiência do “Dia da Avaliação do Curso”, uma avaliação institucional realizada por discentes de uma escola médica pública. RELATO DE EXPERIÊNCIA: A construção da avaliação foi proposta pelos próprios discentes da graduação em medicina, baseado em avaliações como o SAEME e SPICES, objetivando avaliar os eixos: relação docente-discente, infraestrutura e planejamento educacional. O evento ocorreu em dois períodos, com participação de graduandos em medicina. Pela manhã, houve um espaço formativo acerca de diretrizes curriculares, metodologias de ensino, avaliações e saúde mental do estudante, seguida por preenchimento de questionário individual. Durante a tarde, ocorreram os espaços de discussão coletiva, seguidos de uma plenária acerca das principais conclusões de cada grupo e encaminhamento das reivindicações. DISCUSSÃO: Observou-se engajamento estudantil pela participação dos estudantes na política e nas atividades de tomada de decisões; na provisão e avaliação do programa educacional da escola; e quando seu feedback é levado em consideração no desenvolvimento e na revisão do currículo pela instituição. CONCLUSÃO: Essa iniciativa possibilitou acúmulo teórico sobre Educação em Saúde, aquisição de competências de organização, responsabilidade e ética; e demonstrou-se a influência discente direta na melhoria da escola, o enriquecimento da educação médica local e a potencialização do pensamento crítico discente

Inflammation, Diabetes, and Chronic Kidney Disease: Role of Aerobic Capacity

The persistent inflammatory state is common in diabetes and chronic kidney disease (CKD). These patients present exercise intolerance and increased arterial stiffness. Long-term aerobic exercise has been associated with better arterial compliance, antidiabetic and antiinflammatory benefits. We assessed the hypothesis that in patients with diabetes and CKD, better aerobic capacity is associated with less inflammatory state and arterial stiffness. Thirty-nine CKD patients (17 in hemodialysis) were evaluated. According to CKD etiology two patient groups were obtained: group of diabetics (GD) was formed by 11 patients and nondiabetics (GND) formed by 28 patients. Central blood pressure and arterial stiffness were evaluated by Sphygmocor device. Carotida intima-media thickness (CA-IMT) was evaluated by ultrasonography. Aerobic capacity was measured by estimated VO2max according to treadmill test by Bruce protocol. The GD showed a higher frequency of C-reactive protein above laboratory cutoff (P = 0.044), higher frequency of male gender, and a non significant higher value of VO2max (P = 0.099). The CA-IMT was similar. Only better aerobic capacity was associated with lower frequency of high C-reactive protein when adjusted to diabetes and gender in a logistic regression model. In conclusion, aerobic capacity was associated with inflammatory state, in CKD patients, independently of diabetes presence

Clinical Study Inflammation, Diabetes, and Chronic Kidney Disease: Role of Aerobic Capacity

The persistent inflammatory state is common in diabetes and chronic kidney disease (CKD). These patients present exercise intolerance and increased arterial stiffness. Long-term aerobic exercise has been associated with better arterial compliance, antidiabetic and antiinflammatory benefits. We assessed the hypothesis that in patients with diabetes and CKD, better aerobic capacity is associated with less inflammatory state and arterial stiffness. Thirty-nine CKD patients (17 in hemodialysis) were evaluated. According to CKD etiology two patient groups were obtained: group of diabetics (GD) was formed by 11 patients and nondiabetics (GND) formed by 28 patients. Central blood pressure and arterial stiffness were evaluated by Sphygmocor device. Carotida intima-media thickness (CA-IMT) was evaluated by ultrasonography. Aerobic capacity was measured by estimated VO 2 max according to treadmill test by Bruce protocol. The GD showed a higher frequency of C-reactive protein above laboratory cutoff (P = 0.044), higher frequency of male gender, and a non significant higher value of VO 2 max (P = 0.099). The CA-IMT was similar. Only better aerobic capacity was associated with lower frequency of high C-reactive protein when adjusted to diabetes and gender in a logistic regression model. In conclusion, aerobic capacity was associated with inflammatory state, in CKD patients, independently of diabetes presence

High volume peritoneal dialysis vs daily hemodialysis: A randomized, controlled trial in patients with acute kidney injury

There is no consensus in the literature on the best renal replacement therapy (RRT) in acute kidney injury (AKI), with both hemodialysis (HD) and peritoneal dialysis (PD) being used as AKI therapy. However, there are concerns about the inadequacy of PD as well as about the intermittency of HD complicated by hemodynamic instability. Recently, continuous replacement renal therapy (CRRT) have become the most commonly used dialysis method for AKI around the world. A prospective randomized controlled trial was performed to compare the effect of high volume peritoneal dialysis (HVPD) with daily hemodialysis (DHD) on AKI patient survival. A total of 120 patients with acute tubular necrosis (ATN) were assigned to HVPD or DHD in a tertiary-care university hospital. The primary end points were hospital survival rate and renal function recovery, with metabolic control as the secondary end point. Sixty patients were treated with HVPD and 60 with DHD. The HVPD and DHD groups were similar for age ( 64.2 +/- 19.8 and 62.5 +/- 21.2 years), gender ( male: 72 and 66%), sepsis ( 42 and 47%), hemodynamic instability ( 61 and 63%), severity of AKI ( Acute Tubular Necrosis-Index Specific Score (ATN-ISS): 0.68 +/- 0.2 and 0.66 +/- 0.2), Acute Physiology, Age, and Chronic Health Evaluation Score (APACHE II) (26.9 +/- 8.9 and 24.1 +/- 8.2), pre-dialysis BUN (116.4 +/- 33.6 and 112.6 +/- 36.8mg per 100 ml), and creatinine ( 5.8 +/- 1.9 and 5.9 +/- 1.4 mg per 100 ml). Weekly delivered Kt/V was 3.6 +/- 0.6 in HVPD and 4.7 +/- 0.6 in DHD ( P<0.01). Metabolic control, mortality rate ( 58 and 53%), and renal function recovery ( 28 and 26%) were similar in both groups, whereas HVPD was associated with a significantly shorter time to the recovery of renal function. In conclusion, HVPD and DHD can be considered as alternative forms of RRT in AKI

Associations between nutritional markers and inflammation in hemodialysis patients

The purpose of this study is to evaluate associations between clinical, laboratory, demographic, and nutritional markers with inflammatory state and malnutrition in hemodialysis (HD) patients. Fifty-two patients on regular HD were evaluated by clinical, demographic, laboratory, and nutritional parameters (food intake, anthropometric measurements, bioelectric impedance, subjective global assessment-SGA and appetite characteristics). Inflammation (serum C-reactive protein a parts per thousand yen 0.9 mg/dl) was present in 13 (25%) and malnutrition (SGA) in 16 (30.7%) patients. Body mass index (BMI), total lymphocytes count, and phase angle were negative and independently associated with malnutrition. Values of BMI a parts per thousand yen 25 kg/mA(2) were associated with diabetes, positively associated with adipose tissue percentage (BIA) and negatively associated with diastolic blood pressure. Phase angle was positively associated with hematocrit, total lymphocytes count and serum creatinine, and was negatively associated with age. A negative and independent association between muscle mass percentage (BIA) and inflammation was observed. These results suggested that inflammatory state induces muscle mass depletion, while high BMI is associated with diabetes and with lower diastolic blood pressure, a recognized cardiovascular risk factor in uremic patients. Phase angle and SGA were associated with traditional nutritional markers, reinforcing their validity for HD patients.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Continuous peritoneal dialysis compared with daily hemodialysis in patients with acute kidney injury

Background: In some parts of the world, peritoneal dialysis is widely used for renal replacement therapy (RRT) in acute kidney injury (AKI), despite concerns about its inadequacy. It has been replaced in recent years by hemodialysis and, most recently, by continuous venovenous therapies. We performed a prospective study to determine the effect of continuous peritoneal dialysis (CPD), as compared with daily hemodialysis (dHD), on survival among patients with AKI.Methods: A total of 120 patients with acute tubular necrosis (ATN) were assigned to receive CPD or dHD in a tertiary-care university hospital. The primary endpoint was hospital survival rate; renal function recovery and metabolic, acid-base, and fluid controls were secondary endpoints.Results: of the 120 patients, 60 were treated with CPD (G1) and 60 with dHD (G2). The two groups were similar at the start of RRT with respect to age (64.2 +/- 19.8 years vs 62.5 +/- 21.2 years), sex (men: 72% vs 66%), sepsis (42% vs 47%), shock (61% vs 63%), severity of AKI [Acute Tubular Necrosis Individual Severity Score (ATNISS): 0.68 +/- 0.2 vs 0.66 +/- 0.22; Acute Physiology and Chronic Health Evaluation (APACHE) II: 26.9 +/- 8.9 vs 24.1 +/- 8.2], pre-dialysis blood urea nitrogen [BUN (116.4 +/- 33.6 mg/dL vs 112.6 +/- 36.8 mg/dL)], and creatinine (5.85 +/- 1.9 mg/dL vs 5.95 +/- 1.4 mg/dL). In G1, weekly delivered Kt/V was 3.59 +/- 0.61, and in G2, it was 4.76 +/- 0.65 (p < 0.01). The two groups were similar in metabolic and acid-base control (after 4 sessions, BUN < 55 mg/dL: 46 +/- 18.7 mg/dL vs 52 +/- 18.2 mg/dL; pH: 7.41 vs 7.38; bicarbonate: 22.8 +/- 8.9 mEq/L vs 22.2 +/- 7.1 mEq/L). Duration of therapy was longer in G2 (5.5 days vs 7.5 days; p = 0.02). Despite the delivery of different dialysis methods and doses, the survival rate did not differ between the groups (58% in G1 vs 52% in G2), and recovery of renal function was similar (28% vs 26%).Conclusion: High doses of CPD provided appropriate metabolic and pH control, with a rate of survival and recovery of renal function similar to that seen with dHD. Therefore, CPD can be considered an alternative to other forms of RRT in AKI