Parental stress is associated with increased obesogenic family lifestyle behaviors contributing to childhood obesity. Novel interventions are needed to reduce parental stress and improve healthy lifestyle behaviors for preschool-age children and families. The primary study aim was to analyze preliminary effects of a digitally enhanced evidence-based cognitive- behavior skill-building (CBSB) intervention on parental stress and healthy lifestyle behaviors (diet and physical activity) among parents of preschool-age children. A secondary aim was to evaluate feasibility/acceptability of this school-based virtual intervention during the COVID-19 pandemic. The 12-week intervention involved text messaging and three pre-recorded CBSB educational video presentations accessed by parents of preschool-age children (n=21) from a password-protected website. The Healthy Child Healthy Family Behavior Checklist (HCHF) measured lifestyle behaviors. Parent stress was measured using the self-reported Parental Stress Scale (PSS) and parents' hair cortisol concentration (HCC) levels. Paired t-tests/Wilcoxon signed rank tests determined pre/post-intervention differences among healthy family lifestyle behaviors and parental stress. Pearson/Spearman Rho correlations determined if significant relationships existed between parent stress and healthy family lifestyle behaviors. Both parent stress measures were significantly reduced post-intervention (p< .05). A modest increase in HCHF from baseline (M=60.38; SD=6.48) to post-intervention (M=61.43; SD=6.85); [t(20)= -0.695, p=0.487)] was non-significant. No significant correlations were found among the parental stress and HCHF variables. All parental responses about text messaging were positive and most (86%) reported that messages motivated healthy behavior changes. Digitally enhanced CBSB virtually delivered interventions with parents in a school-based setting are feasible/acceptable and may potentially improve parental stress and family lifestyle behaviors.

Orientador: Gastão Wagner de Souza Campos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T13:36:02Z (GMT). No. of bitstreams: 1 Bedrikow_Rubens_M.pdf: 925478 bytes, checksum: 42b8fb31187838282acbd04273b90270 (MD5) Previous issue date: 2008 / Resumo: A partir de 2001, no bojo da reorganização do modelo de atenção à saúde no município de Campinas, surge a proposta de ampliação da clínica, valorizando o sujeito e o contexto, além da doença. Este estudo propôs-se a fazer uma reflexão sobre a clínica praticada em mulheres com dor osteomuscular crônica decorrente de tendinite, lesão por esforço repetitivo, lombalgia e fibromialgia, a partir da atividade do pesquisador como médico em uma unidade básica de saúde. O objetivo foi conhecer o significado da dor para essas mulheres e discutir como esse conhecimento poderia contribuir com a ampliação da clínica. O referencial teórico abarcou questões como a inserção da mulher na sociedade e no trabalho, o Programa de Saúde da Família, o significado da dor e os tipos de clínica. A metodologia incluiu a aplicação de questionário, realização de entrevistas e estudo de prontuários. A maioria das pacientes estudadas exerce atividades ocupacionais que exigem esforço físico diário ou movimentos repetitivos. Esse é o caso das faxineiras, domésticas, costureira, servente, auxiliar de cozinha, salgadeira e atendente de cafeteria, ocupações tipicamente femininas, pois são consideradas como extensão das atribuições do lar. Responsabilizam-se ainda pelos afazeres domésticos e contribuem ou garantem a renda familiar. Desvantagens determinadas pela cultura de gênero, em particular na divisão de responsabilidades entre homens e mulheres no cuidado dos filhos e do lar e na inserção no mercado de trabalho, parecem contribuir com o aparecimento ou manifestação da dor. Não obstante haverem atribuído a dor às tarefas profissionais e domésticas, têm a percepção de que a dor significa mais que um simples problema físico, guardando também relação com questões sentimentais e com suas histórias de vida. Os sentimentos revelados foram tristeza, solidão, angústia, desespero, nervosismo, irritação, depressão, desânimo, agitação, mal-humor, fracasso e ansiedade. As entrevistas abertas captaram ou aprofundaram várias questões geradoras de sofrimento, ligadas à subjetividade de cada paciente, que não haviam sido detectadas pela clínica tradicional. Mostraram também que a dor, muitas vezes, sinaliza sofrimento pessoal, pedido de ajuda ou atenção. Sob a ótica das pacientes, essas questões não biológicas têm grande relevância e precisam ser valorizadas pelos profissionais de saúde. Diante da constatação de que tais questões vieram à tona apenas quando as mulheres encontraram espaço para falar livremente de si, o pesquisador concorda não somente com a mudança na dinâmica tradicional da consulta, mas também, e principalmente, com o acompanhamento do sujeito no seu caminhar na vida, assim como de sua família, conforme preconizado pela Estratégia de Saúde da Família, em particular no modelo proposto por Campos (2003), enfatizando o estabelecimento de vínculo e a adoção da clínica ampliada / Abstract: Since 2001, at the summit of the health attention model rearrangement in the city of Campinas, there has come about a clinical improvement proposal valorizing the subject in her context besides the disease itself. This study suggests a reflection about the clinical practice in women undergoing chronic osteomuscular pain due to tendinitis, RSI (Repetitive Strain Injury), back pain, and fibromyalgia, from the researcher¿s activities as a physician in a public health care unit. The goal was to understand the meaning of pain to these women and to discuss how this knowledge would contribute to clinical improvement and expansion. The theoretical reference encompassed issues such as women insertion in the society and work, the Brazilian government ¿Family Health Program¿, the source of their pain and the types of clinical assessment. The methodology involved the utilization of a questionnaire, interviews, and the analysis of medical charts. Most patients enrolled in the study carry out occupational tasks that require daily physical strain or repetitive movements. This is the case of housekeepers, maids, sewing women, servants, kitchen helpers, appetizer (Brazilian snacks) makers, cafeteria attendants, all typical women occupations since they¿re seen as an extension of household attributions. These women are also in charge of domestic chores and contribute or provide the family income. Disadvantages determined by the local gender culture, in particular the distribution of household responsibilities among men and women as to taking care of home and children and insertion in the working market seem to contribute to the appearance or manifestation of pain. However, although they have attributed the pain to professional and household chores, they have the feeling that pain means more than a simple physical problem, but it is related to sentimental issues and their personal life stories. The feelings disclosed were sadness, loneliness, anguish, despair, nervousness, irritation, depression, hopelessness, agitation, bad mood, failure, and anxiety. The open interviews detected or went deep into several issues that generated suffering which were linked to subjective aspects of each individual patient not noticed in previous traditional clinical appointments. They also demonstrated that pain quite often signalizes personal suffering or a cry for help and attention. Under the patients¿ view, such non-biological issues are in fact relevant and need to be taken into consideration by health professionals. Facing the fact that these issues were only revealed when women felt at ease to talk freely about themselves, the researcher agrees not only with the change in the traditional appointment dynamics, but also, and specially, with the need to follow-up the subject throughout her life, as well as her family, as preconized by the Family Heath Strategy, in particular the model proposed by Campos (2003), emphasizing the establishment of a bond and the adoption of an expanded clinical attention / Mestrado / Saude Coletiva / Meste em Saude Coletiva

Abstract Purpose: With the US reporting 20 million newly diagnosed STI/HIV cases annually, clinical guideline compliance and EBP recommendation implementation necessitate provider practice changes for high-quality routine sexual and reproductive health services. The project's purpose was to improve sexual health history-taking (SHH) and documentation in a private primary care practice (PPCP) serving high-risk populations. The DNP project aims to determine the effect of conducting a 30-minute educational session and implementing the CDC's 5Ps on a PCP's clinical guideline adherence to SHH recommendations and documentation with patients presenting for annual wellness exams, well-woman exams, family/contraceptive counseling, or acute urogenital complaints in an urban, southeastern PPCP. Methodology: The quality improvement (QI) project implemented a standardized clinical practice change using the Stetler model's practitioner-oriented knowledge translation design. PPCP-employed NPs (n = 3) completed anonymous pre-/post-implementation surveys using SurveyMonkey, received educational resources, and implemented the CDC's 5Ps SHH tool for clinically appropriate patient encounters identified by eligible ICD-10 codes. Athena's Report Builder compiled data on SHH completion/EMR documentation and providers' intervention compliance from 2-weeks before and 2-weeks after implementation. Results: Over the four-week project period, a total of n = 1,031 EMR charts [pre-implementation (n = 513)/post-implementation (n = 518)] were reviewed for SHH completion/EMR documentation. Analysis of eligible encounters’ charts showed significant improvement in post-implementation SHH completion/EMR documentation rates (37% in pre-intervention; 82% in post-intervention). The chi-square test findings [X2 (1, N = 1031) = 43.637, p < .01] displayed a significant relation between the variables, indicating an increased likelihood of sexual health history EMR documentation by implementing the CDC'S 5Ps SHH tool. Provider survey results indicated providers support implementation and routine clinical practice of the CDC's 5Ps. Limitations: Provider sample size (n =3), geographical location, demographics served, private ownership, and SUD treatment center association limit the study's generalizability. Implications for Practice: The PPCP’s SHH tool availability for clinically relevant encounters increased SHH EMR documentation completion and frequency rates––utilizing the brief, cost-effective intervention for evaluating sexual health risks and behaviors to decrease the likelihood of adverse outcomes. Through positive, nonjudgmental sexual health information acquisition, providers can better facilitate difficult conversations with patients, promote sexual health awareness, and improve STI/HIV screening/treatment rates in a private primary care practice setting. Keywords: sexual health history

<p>To date most research on long-term outcomes of childhood trauma has focused on traumatic brain injuries, but less is known about traumatic injuries not involving the brain. Since traumatic brain injuries can have persistent effects on child behaviour, I investigated whether other types of traumatic injuries could also affect child behaviour in the long term. Currently, limited information is available on possible associations between family function and child behaviour after child trauma; knowledge of the long-term costs of pediatric trauma is also lacking. The main goal of this study was to determine whether family function was associated with behaviour in children who experienced a traumatic injury eight to ten years ago. Additional goals were to determine current expenditures and use of health and social services by child trauma victims and their parents. Pediatric trauma victims were selected from a trauma database at a tertiary care hospital in the Hamilton-Wentworth region. The parents of these children were interviewed to obtain children’s current behaviours and the family’s use of health and social services. The results showed that injury severity was not associated with child behaviour, but associated with family functioning. No relationship was found between health and social service expenditures for children and their injury severity, but there was a relationship between parent health and social service expenditures and child injury severity. The results do not support an association between child behaviour and injury severity following trauma, but they do suggest that expenditures and use of services by injured children and their families are affected long-term. The results suggest that future health and social service uses of injured children and their families may be better understood and planned for by recognizing the continuing effects of trauma. This information could help making appropriate health and social service programs more available to this population.</p> / Master of Science (MSc)

ABSTRACT Background: Morbidity patterns of patients attending general practices in Soweto, a suburban township south of Johannesburg, were studied using the international classification of primary care (ICPC) as a coding instrument. The ICPC was used to code reasons for encounter and diagnosis. One hundred and one private practices were in Soweto at the time of the survey and thirty-one of these practices were selected using random number tables to obtain as wide a distribution of geographical and socio economic groups as possible. Aim: The aim of this study is to determine the morbidity patterns of patients attending general practices in Soweto during a week in November of the summer of 1997; and a week in June of the winter of 1998. Objectives: 1) To determine demographic details of responding general practitioners in Soweto including sex, age and area of practice. 2) To determine socio-demographic features of patients attending practitioners in Soweto including age, sex, highest educational level, and occupation. Township of residence, housing details, namely number of rooms in residence, and number of persons living in residence. 3) To determine the initiator of the consultation, namely whether it was doctor initiated, patient initiated, or referred to the practitioner from another practitioner or clinic. IV 4) To determine factors related to the condition for which the patient consulted the doctor, including reason for encounter, diagnosis and whether the presenting problem was a new or an ongoing problem. 5) To determine the relationships between the above variables. Design: A prospective descriptive study design was employed in which doctors completed a survey questionnaire of all patients attended to in their practices during two weeks, one week in summer and one week in winter. Results: The 25 doctors in summer and the 20 doctors in winter, included in the survey described 4,432 encounters. These patients presented with 5,710 problems. Forty point three percent of patients (1780) were male and 59,7% patients (2,632) were female. Fifty two percent of patients (2306) were seen in summer and 48% (2,125) patients were seen in winter allowing the comparison of seasonal variation in morbidity patterns. The majority of patients were in the 20 to 50 year age group, followed by those under ten years of age. In all age groups, except children under the age of ten years, there were more encounters with females than males. In under ten year olds, male encounters were more than female encounters for all ages and twice as frequent as female encounters in the group under the age of one year. Most patients had a secondary education and lived in four roomed houses. Upper respiratory tract infections constituted, 16% (767) of the diagnoses and cough accounted for 16.1% (901) of all the reasons for encounter in all age groups especially in children below the age of 10 years. Digestive complaints were second most common reason for encounter and V diagnoses in the younger children especially in boys. Encounters and diagnoses associated with the eye, male genital system, female genital system, pregnancy and child bearing, ear, psychological, social and blood immune system disorders each accounted for less than 2% of the encounters experienced. Complaints of the musculoskeletal system were frequent in older patients. Family planning, vaginal discharge and painful urination occurred in the 10 to 50 year old age groups. As for encounters, diagnoses were age related with hypertension and osteoarthritis being the most common chronic disease afflicting patients over 30 years of age. Nineteen point seven percent (870) of the patients belonged to the trade and technical occupation, 13.6% (604) of the patients were children, 12.2% (539) of patients were unemployed, 9.6% (423) of patients were scholars, 9.4% (414) were professional, 8.6% (379) of patients were students, 8.1% (360) were pensioners and 7.6% (338) were office workers. Seven point three percent of the patients (325) were Labourers, and 3.9% (172) of the patients were housewives. Thirteen point seven percent of the patients (605) were from Meadowlands, 13% (577) from Dobsonville, 7.2% (318) from other areas outside Soweto, 6.7% (298) were from Orlando East, 6.6% (294) were from Zola and 6.1% (270) from Chiawelo. Less then 5% of the patients came from the remaining townships. Discussion: The present survey recorded encounters of 25 general practitioners in Summer and 20 general practitioners in Winter, with 4,432 patients and 5,710 VI problems. The week time period of the present survey is similar to that of Bourne et al. which determined the morbidity spectrum seen by a representative sample of 8% of the medical practitioners in South Africa in 1985. The sample size of the present study is considerably smaller than the comprehensive Cape Morbidity study, which was conducted over 1 year and recorded 49,347 diagnoses by 15 practitioners. This survey included 38,368 white patients and 14,979 patients of mixed racial origin but no blacks were included. The same limitation applies to the pilot survey conducted by Bloom et al in Cape Town between 1984 and 1988, where 13 practices recorded 64,959 encounters. Studies conducted outside South Africa are similar to those conducted within the country. This survey in comparison with other countries reflects consistency in the incidence of illness encountered by the family practitioner and also contemporary trends in morbidity seen in general practice. Most of the inhabitants of Soweto still make use of coal-stove fires and the town ship is usually enveloped in pall of heavy smoke coming from these coal stove fires. The main impression of Soweto is that of overcrowding and poverty, and still struggling in providing basic services including potable toilets to its poorer districts. Schools in Soweto remain largely without flushed toilets, furniture and electricity. Most of Soweto still has row upon row of so call matchbox houses crowded into unpaved dusty streets that are poorly lit. The above conditions explain the high reasons for encounter and diagnoses of respiratory and digestive conditions among the patients attending the private practices. This study shows that an enormous amount of everyday illness occurs in children and therefore education and advice for parents on how to cope with illness in their children remains important. VII Study Limitation: This survey was conducted in an impoverished township community where many people would attend clinics. It has selected encounters where the patients have the ability to pay for the services of a medical doctor. Conclusion: Few studies appear to be as comprehensive as this study where the reasons of encounter, the diagnosis, patient demographic and socio-economic data was recorded. This is also the largest survey conducted in an urbanized South African township. This survey has found a similar trend in the spectrum of disease, therefore providing a significant analysis of morbidity patterns encountered by the family practitioner in Soweto. There is an on going concern of the role of sexually transmitted diseases in the transmission of HIV, and this study has shown a significant burden of sexually transmitted disease in the asymptomatic population, particularly women in the age group 20 to 30 and 30 to 40 years. The overall burden of diseases in Soweto shows that respiratory problems are significant in all age groups. Chronic diseases such hypertension, osteoarthritis, presumed gastrointestinal infections, asthma and malignant neoplasm of the stomach as well as the anxiety disorders also featured prominently in the top 20 reasons for encounter and diagnoses. Information about mental health status in South Africa is scanty and has possibly led to an inadequate identification of a potential problem. This study has shown anxiety disorder/anxiety state as being a common reason for encounter and diagnoses in adults attending private practices in Soweto. To determine whether this survey reflects the morbidity patterns in this population as a whole would require additional data from the Government hospitals and clinics.

INTRODUÇÃO: Alterações cognitivas em pacientes idosos não são freqüentemente detectadas pelo médico generalista, de acordo com a literatura médica. No Brasil, assim como em outros países, o indivíduo idoso é atendido rotineiramente pelo clínico geral. Neste estudo, verificou-se se alterações da cognição em idosos diagnosticadas por especialistas haviam sido detectadas anteriormente pelos médicos generalistas que acompanham estes indivíduos. Verificou-se também se os instrumentos utilizados na detecção de alterações cognitivas tiveram boa eficácia e foi proposto o uso de alguns deles na prática clínica de rotina do médico generalista. MÉTODOS: Neste estudo de corte transversal, de uma lista de indivíduos idosos atendidos por médicos generalistas em dois serviços de clínica médica geral do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, foi selecionada uma amostra de forma aleatória. Foi realizada convocação por telefone para que os idosos participassem de pesquisa clínica na qual teriam uma avaliação cognitiva e funcional realizada por um médico geriatra. Constavam dessa avaliação: Mini Exame do Estado Mental (MEEM), Short Informant Questionnaire on Cognitive Decline in the Elderly (Short-IQCODE), Bateria Cognitiva Breve (BCB), Questionário de Avaliação Funcional de Pfeffer (QAF-Pfeffer) e Escala de Depressão Geriátrica de 15 itens (GDS). Os indivíduos foram classificados inicialmente como suspeitos de alteração cognitiva ou não, de acordo com os escores do MEEM e/ou Short-IQCODE. Os suspeitos foram submetidos à análise laboratorial de sangue e realizaram tomografia de crânio, além de terem sido encaminhados à avaliação neuropsicológica. Os indivíduos suspeitos (N=52) e uma subamostra de não-suspeitos (N=53) tiveram diagnósticos nosológicos realizados por meio de discussão entre o pesquisador e dois neurologistas com experiência em demências. Todos os prontuários dos serviços de clínica geral dos suspeitos e da subamostra de não-suspeitos foram analisados procurando-se encontrar anotações a respeito de declínio da cognição. Calculou-se a sensibilidade e a especificidade dos instrumentos utilizados no diagnóstico de demência e de Comprometimento Cognitivo Leve. Calculou-se também a sensibilidade e a especificidade do uso conjunto de alguns instrumentos considerados de fácil aplicação e interpretação. RESULTADOS: 248 pacientes, com mediana de idade de 70 anos e, de escolaridade, de 4 anos, foram submetidos à análise inicial. Cinqüenta e dois indivíduos foram classificados como suspeitos e, desses, 21 tiveram diagnóstico de demência, e 22 de Comprometimento Cognitivo Leve. Em sete (16,27%) prontuários dos serviços de clínica geral dos indivíduos que tiveram diagnóstico de demência e de comprometimento cognitivo havia anotações a respeito de alterações cognitivas. Não houve anotações a respeito de alterações cognitivas nos prontuários dos não-suspeitos. O instrumento utilizado que demonstrou maior eficácia no diagnóstico de declínio cognitivo (demência e Comprometimento Cognitivo Leve) foi o QAF-Pfeffer, com sensibilidade de 84% e especificidade de 94%. Para o diagnóstico de declínio cognitivo, houve aumento da sensibilidade do QAF-Pfeffer quando se analisou a aplicação conjunta desse instrumento com, respectivamente, os testes do desenho do relógio, da fluência verbal (que são instrumentos de fácil aplicação) e o item memória tardia da BCB. As sensibilidades e xv especificidades para o diagnóstico de declínio cognitivo com o uso conjugado do QAF-Pfeffer foram, respectivamente, de 88,4% e 93,5% com o teste de fluência verbal, 93% e 92,5% com o desenho do relógio e de 86,4% e 89,6 % com o item memória tardia da BCB. CONCLUSÕES: O presente estudo conclui que o declínio cognitivo de pacientes idosos é pouco detectado por médicos generalistas em nosso meio. Esse achado é semelhante ao observado em estudos realizados em outros países. Alguns instrumentos apresentaram boa eficácia no diagnóstico das alterações cognitivas, e o uso combinado desses instrumentos aumentou a sensibilidade observada ao utilizá-los isoladamente. Os testes que tiveram melhor desempenho possuem características que os fazem bons instrumentos para o uso de médico generalista, já que são de fácil e rápida aplicação e simples interpretação, características fundamentais em ambientes com altas demandas de pacientes e limitações de tempo para as consultas. Destes, o teste de fluência verbal tem as vantagens da rapidez e de prescindir de quaisquer instrumentos para sua aplicação / INTRODUCTION: Elderlys cognitive impairment is often overlooked by the general practitioner, according to medical literature. In Brazil, as in several other countries, older adults are routinely followed by the general practitioner. This study verified if elderly patients cognitive impairment diagnosed by specialized physicians had such impairment recognized by their general practitioners. Also, it was verified if the cognitive tests and functional scales used in the diagnosing process of cognitive impairment had good efficacy. Some of the instruments used in this diagnosing process were suggested to be used by general practitioners in their working sets. METHODS: In this transversal cut study, a list of elderly outpatients followed by general practitioners at Hospital das Clínicas (Faculty of Medicine, University of São Paulo) was acquired randomly. These subjects were invited by telephone to participate in a clinical study and then submitted to cognitive and functional evaluation by a geriatrician. This evaluation consisted of: Mini Mental State Exam (MMSE), Short Informant Questionnaire on Cognitive Decline in the Elderly (Short-IQCODE), Brief Cognitive Battery, Pfeffer Functional Activities Questionnaire (Pfeffer-FAQ) and Geriatric Depression Scale (GDS) with 15 items. MMSE and/or Short-IQCODE scores were chosen to classify these individuals into suspected cognitive impairment cases or otherwise. The suspects underwent blood analysis and brain computed tomography scan. They also had neuropsychological evaluation (Dementia Rating Scale) performed by a neuropsychologist. The suspects (N=52) and a sample of non-suspects (N=53) were given different diagnosis regarding cognitive impairment through consensus between the researcher and two neurologists with experience in dementia. The general practitioners files of all the suspects and of a sample of non-suspects were checked in order to find notes on cognitive decline. Sensitivity and specificity of the instruments used in the diagnosing process of cognitive impairment (dementia and mild cognitive impairment) were calculated. Easily applicable screening methods were performed in combination and tested for their combined sensitivity and specificity. RESULTS: Two hundred and forty-eight patients, with age and schooling median of 70 years and four years were initially submitted to screening. Fifty two patients were classified as suspects. Of these 52 suspects, 21 had dementia and 22 were classified as having mild cognitive impairment. In seven (16.27%) of these patients (dementia and mild cognitive impairment) records of the general practitioner there were notes on cognitive decline. There were no notes on cognitive decline in general practitioners records of those non-suspects that were given some type of diagnosis. Pfeffer-FAQ had the best sensitivity and specificity considering cognitive impairment (dementia and mild cognitive impairment) diagnosis. For diagnosis of cognitive impairment, Pfeffer-FAQ sensitivity was 84% and specificity, 94%. Pfeffer-FAQ combined with verbal fluency came out with a sensitivity of 88.4% and a specificity of 93.5%; with clock drawing test, 93% and 92.5% and with delayed recall item of Brief Cognitive Battery, 86.4% and 89.6%. CONCLUSION: This study concludes that cognitive decline of elderly patients is not often detected by general practitioners. This finding is similar to that observed in research carried out in other countries. Some instruments used for the diagnosis of cognitive impairment showed good efficacy and some combinations of these instruments increased their sensitivity. The tests with better performance in the diagnosing process of cognitive impairment are easy and fast to apply besides being easy to be interpreted, which make them good tools in working sets with high demand of patients and little time to attend them. Of the tests with best performances, verbal fluency seems to be the most interesting since patients do not even need a pencil to get it done nor appliers need a great amount of time to give back the result of the test

The purpose of this study was to collect information regarding healthcare worker (HCW) vaccination policies in Utah family practice clinics. Data sources: The study was conducted in Utah family practice clinics in the most densely populated counties in the state and was a cross-sectional descriptive design. Data were collected from 155 family practice clinic managers. Analyses included frequencies and percentages for quantitative items and a content analysis for open-ended items. Conclusions: HCWs are employed in environments where infectious diseases can be easily spread from person to person, thus, vaccinations can be instrumental in protecting the health of HCWs and patients alike. In Utah, 56.8% of family practice clinics had either no vaccination policy for HCWs or had a policy with no consequences for noncompliance. Utah family practice clinics need to implement changes to create and maintain HCW vaccination policies. Implications for practice: Nurse practitioners can be leaders and change agents by working with their county and state health departments to create state-wide policies that mirror the position statements from the American Nurses Association and the American Association of Nurse Practitioners.

Diss. (sammanfattning) Stockholm : Karol inst., 2004. / Härtill 5 uppsatser.

nÃo hà / The lack of a skills-based curriculum to guide and qualify the residents` education is a reality in several Residency programs in the country. This vulnerability has been discussed by residents, preceptors and coordination of the residency program of family and community medicine (PRMFC), which generated the need of the development of this research. This fact brings the following vulnerabilities: lack of clarity of the learning objectives, educational strategies and the evaluation to be addressed to the residents. Initially, a literature review of the competency-based curricula and a review of documents prepared by associations, societies and professional bodies were conducted. Then we conducted a teacher training course for the preceptors of the PRMFC, with discussions on the theoretical bases of the competency-based curriculum; active learning methodologies; planning and conducting educational activities and strategies; and learning evaluation. After this training, workshops were held for the development of an array of macro competencies. This work trained 12 preceptors of PRMFC and allowed the construction of an array of macro competencies. It will surely facilitate the teaching-learning process in a two-year Residency Program, evaluating the skills of the residents at the end of the course, which guarantees to society a professional able to develop its actions. With a competency-based curriculum specific designed for Family Medicine and for Primary Health Care, we wish to reorient the teaching-learning processes of residents and preceptors to qualify clinical practice. / A falta de um currÃculo baseado em competÃncias para nortear e qualificar o ensino dos residentes à uma realidade em vÃrios os Programas de ResidÃncia no paÃs. Esta vulnerabilidade foi problematizada por residentes, preceptores e coordenaÃÃo do Programa de ResidÃncia de Medicina de FamÃlia e Comunidade (PRMFC), o que gerou a necessidade do desenvolvimento deste estudo. Este fato traz as seguintes vulnerabilidades: falta de clareza dos objetivos de aprendizado, das estratÃgias educacionais e de avaliaÃÃo a serem abordadas. Inicialmente foi realizada uma revisÃo da literatura sobre os currÃculos baseados em competÃncia e uma anÃlise dos documentos elaborados por associaÃÃes, sociedades e entidades profissionais. Em seguida foi realizado um curso de formaÃÃo docente para os preceptores do PRMFC, com discussÃes sobre as bases teÃricas do currÃculo baseado em competÃncia; metodologias ativas de aprendizagem; planejamento e conduÃÃo de estratÃgias e atividades educacionais; e avaliaÃÃo da aprendizagem. ApÃs a capacitaÃÃo foram realizadas oficinas de desenvolvimento de uma matriz de macrocompetÃncias. Esta trabalho traz como produtos a capacitaÃÃo de 12 preceptores do PRMFC e a construÃÃo de uma matriz de macrocompetÃncias. Certamente irà para favorecer o processo de ensino-aprendizagem nos dois anos de programa, avaliando as competÃncias dos residentes no final do curso, o que garante para a sociedade um profissional apto para desenvolver as suas aÃÃes. Com um currÃculo baseado em competÃncias necessÃrias para MFC e APS desejamos reorientar os processos de ensino-aprendizagem dos residentes e preceptores para qualificar a prÃtica.

INTRODUÇÃO: Alterações cognitivas em pacientes idosos não são freqüentemente detectadas pelo médico generalista, de acordo com a literatura médica. No Brasil, assim como em outros países, o indivíduo idoso é atendido rotineiramente pelo clínico geral. Neste estudo, verificou-se se alterações da cognição em idosos diagnosticadas por especialistas haviam sido detectadas anteriormente pelos médicos generalistas que acompanham estes indivíduos. Verificou-se também se os instrumentos utilizados na detecção de alterações cognitivas tiveram boa eficácia e foi proposto o uso de alguns deles na prática clínica de rotina do médico generalista. MÉTODOS: Neste estudo de corte transversal, de uma lista de indivíduos idosos atendidos por médicos generalistas em dois serviços de clínica médica geral do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, foi selecionada uma amostra de forma aleatória. Foi realizada convocação por telefone para que os idosos participassem de pesquisa clínica na qual teriam uma avaliação cognitiva e funcional realizada por um médico geriatra. Constavam dessa avaliação: Mini Exame do Estado Mental (MEEM), Short Informant Questionnaire on Cognitive Decline in the Elderly (Short-IQCODE), Bateria Cognitiva Breve (BCB), Questionário de Avaliação Funcional de Pfeffer (QAF-Pfeffer) e Escala de Depressão Geriátrica de 15 itens (GDS). Os indivíduos foram classificados inicialmente como suspeitos de alteração cognitiva ou não, de acordo com os escores do MEEM e/ou Short-IQCODE. Os suspeitos foram submetidos à análise laboratorial de sangue e realizaram tomografia de crânio, além de terem sido encaminhados à avaliação neuropsicológica. Os indivíduos suspeitos (N=52) e uma subamostra de não-suspeitos (N=53) tiveram diagnósticos nosológicos realizados por meio de discussão entre o pesquisador e dois neurologistas com experiência em demências. Todos os prontuários dos serviços de clínica geral dos suspeitos e da subamostra de não-suspeitos foram analisados procurando-se encontrar anotações a respeito de declínio da cognição. Calculou-se a sensibilidade e a especificidade dos instrumentos utilizados no diagnóstico de demência e de Comprometimento Cognitivo Leve. Calculou-se também a sensibilidade e a especificidade do uso conjunto de alguns instrumentos considerados de fácil aplicação e interpretação. RESULTADOS: 248 pacientes, com mediana de idade de 70 anos e, de escolaridade, de 4 anos, foram submetidos à análise inicial. Cinqüenta e dois indivíduos foram classificados como suspeitos e, desses, 21 tiveram diagnóstico de demência, e 22 de Comprometimento Cognitivo Leve. Em sete (16,27%) prontuários dos serviços de clínica geral dos indivíduos que tiveram diagnóstico de demência e de comprometimento cognitivo havia anotações a respeito de alterações cognitivas. Não houve anotações a respeito de alterações cognitivas nos prontuários dos não-suspeitos. O instrumento utilizado que demonstrou maior eficácia no diagnóstico de declínio cognitivo (demência e Comprometimento Cognitivo Leve) foi o QAF-Pfeffer, com sensibilidade de 84% e especificidade de 94%. Para o diagnóstico de declínio cognitivo, houve aumento da sensibilidade do QAF-Pfeffer quando se analisou a aplicação conjunta desse instrumento com, respectivamente, os testes do desenho do relógio, da fluência verbal (que são instrumentos de fácil aplicação) e o item memória tardia da BCB. As sensibilidades e xv especificidades para o diagnóstico de declínio cognitivo com o uso conjugado do QAF-Pfeffer foram, respectivamente, de 88,4% e 93,5% com o teste de fluência verbal, 93% e 92,5% com o desenho do relógio e de 86,4% e 89,6 % com o item memória tardia da BCB. CONCLUSÕES: O presente estudo conclui que o declínio cognitivo de pacientes idosos é pouco detectado por médicos generalistas em nosso meio. Esse achado é semelhante ao observado em estudos realizados em outros países. Alguns instrumentos apresentaram boa eficácia no diagnóstico das alterações cognitivas, e o uso combinado desses instrumentos aumentou a sensibilidade observada ao utilizá-los isoladamente. Os testes que tiveram melhor desempenho possuem características que os fazem bons instrumentos para o uso de médico generalista, já que são de fácil e rápida aplicação e simples interpretação, características fundamentais em ambientes com altas demandas de pacientes e limitações de tempo para as consultas. Destes, o teste de fluência verbal tem as vantagens da rapidez e de prescindir de quaisquer instrumentos para sua aplicação / INTRODUCTION: Elderlys cognitive impairment is often overlooked by the general practitioner, according to medical literature. In Brazil, as in several other countries, older adults are routinely followed by the general practitioner. This study verified if elderly patients cognitive impairment diagnosed by specialized physicians had such impairment recognized by their general practitioners. Also, it was verified if the cognitive tests and functional scales used in the diagnosing process of cognitive impairment had good efficacy. Some of the instruments used in this diagnosing process were suggested to be used by general practitioners in their working sets. METHODS: In this transversal cut study, a list of elderly outpatients followed by general practitioners at Hospital das Clínicas (Faculty of Medicine, University of São Paulo) was acquired randomly. These subjects were invited by telephone to participate in a clinical study and then submitted to cognitive and functional evaluation by a geriatrician. This evaluation consisted of: Mini Mental State Exam (MMSE), Short Informant Questionnaire on Cognitive Decline in the Elderly (Short-IQCODE), Brief Cognitive Battery, Pfeffer Functional Activities Questionnaire (Pfeffer-FAQ) and Geriatric Depression Scale (GDS) with 15 items. MMSE and/or Short-IQCODE scores were chosen to classify these individuals into suspected cognitive impairment cases or otherwise. The suspects underwent blood analysis and brain computed tomography scan. They also had neuropsychological evaluation (Dementia Rating Scale) performed by a neuropsychologist. The suspects (N=52) and a sample of non-suspects (N=53) were given different diagnosis regarding cognitive impairment through consensus between the researcher and two neurologists with experience in dementia. The general practitioners files of all the suspects and of a sample of non-suspects were checked in order to find notes on cognitive decline. Sensitivity and specificity of the instruments used in the diagnosing process of cognitive impairment (dementia and mild cognitive impairment) were calculated. Easily applicable screening methods were performed in combination and tested for their combined sensitivity and specificity. RESULTS: Two hundred and forty-eight patients, with age and schooling median of 70 years and four years were initially submitted to screening. Fifty two patients were classified as suspects. Of these 52 suspects, 21 had dementia and 22 were classified as having mild cognitive impairment. In seven (16.27%) of these patients (dementia and mild cognitive impairment) records of the general practitioner there were notes on cognitive decline. There were no notes on cognitive decline in general practitioners records of those non-suspects that were given some type of diagnosis. Pfeffer-FAQ had the best sensitivity and specificity considering cognitive impairment (dementia and mild cognitive impairment) diagnosis. For diagnosis of cognitive impairment, Pfeffer-FAQ sensitivity was 84% and specificity, 94%. Pfeffer-FAQ combined with verbal fluency came out with a sensitivity of 88.4% and a specificity of 93.5%; with clock drawing test, 93% and 92.5% and with delayed recall item of Brief Cognitive Battery, 86.4% and 89.6%. CONCLUSION: This study concludes that cognitive decline of elderly patients is not often detected by general practitioners. This finding is similar to that observed in research carried out in other countries. Some instruments used for the diagnosis of cognitive impairment showed good efficacy and some combinations of these instruments increased their sensitivity. The tests with better performance in the diagnosing process of cognitive impairment are easy and fast to apply besides being easy to be interpreted, which make them good tools in working sets with high demand of patients and little time to attend them. Of the tests with best performances, verbal fluency seems to be the most interesting since patients do not even need a pencil to get it done nor appliers need a great amount of time to give back the result of the test