Bibliographische Beschreibung Petra Hönigschmid Motivierung von Medizinstudenten zur allgemeinärztlichen Tätigkeit durch Hausärztliche Praktika – eine Prä-Post-Studie Universität Leipzig, Dissertation 62 Seiten, 20 Tabellen, 1 Abbildung, 36 Literaturverweise Referat: In der vorliegenden Arbeit wurde untersucht, inwieweit frühzeitige hausärztliche Praktika am Beispiel des Leipziger Wahlfachs Allgemeinmedizin Vorklinik die Einstellung und den Berufswunsch zur Hausarztmedizin beeinflussen. In einer Prä-Post-Studie wurden alle für dieses Wahlfach eingeschriebenen Medizinstudenten der Universität Leipzig von Februar 2008 bis Februar 2010 befragt. Es konnte gezeigt werden, dass bei einem geeigneten Lehrkonzept die Ausbildung bei niedergelassenen Hausärzten einen positiven Effekt auf die Karrierewahl Allgemeinmedizin hat. Die große Bandbreite an Erkrankungen, die Behandlung komplexer Krankheitsbilder und der Aufbau langfristiger Patientenbeziehungen wurden dabei sehr geschätzt. Nach dem Praktikum stieg der Berufswunsch Allgemeinmedizin signifikant an. Etwa die Hälfte der Studierenden konnte sich eine niedergelassene Tätigkeit vorstellen. Bezüglich der Kontrollierbarkeit der wöchentlichen Arbeitszeit und der Organisation eines vernünftigen Verhältnisses zwischen Arbeit und Freizeit gab es nach dem Praktikum keine wesentlichen Abweichungen. Die Studierenden schätzten dies als realisierbar ein. Auch eine höhere Arbeitsbelastung des Hausarztes im Vergleich zu anderen Fachärzten konnte nach dem Praktikum nicht bestätigt werden. Die vermutete Arbeitszeit eines Hausarztes wurde nach dem Praktikum nach oben korrigiert. Das Interesse an einer Famulatur, einem PJ-Tertial oder einer Promotion in der Allgemeinmedizin war nach dem Praktikum unverändert hoch. Die Evaluierung der Lehrveranstaltung zeigte, dass die Arbeitsweise des Lehrarztes und die damit verbundene Vorbildwirkung für die Studierenden einen wesentlichen Aspekt für die spätere Karrierewahl darstellen.

Many babies are delivered by using the standard lithotomy birthing position. However, evidence shows several benefits to an upright birthing position. The purpose of this study is to discover birthing positions that lead to more positive outcomes in laboring women delivering in hospitals. This research was conducted by examining previous studies conducted on a similar topic. However, the studies found mainly focused on the benefits of squatting positions and the implementation of devices that helps achieve an upright position. All findings support an upright birthing position provides a more optimal position for birthing a child due to the force of a more natural pelvic expansion and gravity. One of the barriers of this area of study includes the lack of pregnant mothers willing to participate in a study skewing the reliability of many studies. In conclusion, the articles analyzed provide pertinent information that supports the intervention of nurses and midwives providing patient education to explore birthing options outside of standard practice that could lead to more positive outcomes.

Introduction & Background: Female athletes are at risk for developing eating disorders, they feel the need to engage in dieting, fasting, vomiting, and diet pills. These actions impact 35-57% of female athletes. An eating disorder can be defined as a variety of mental conditions that are characterized by an imbalance in eating and a weakness in physical or mental health. The female athlete triad is three components including osteoporosis, eating disorders, and amenorrhea (absence of menstrual cycle). Purpose Statement & Research Question: For female athletes around the ages of 18-23, what is the risk of eating disorders compared to their involvement in a competitive sport within the years they are participating in their sport? Literature Review: Sources were pulled from the CINAHL database, these articles are under 5 years of age. Findings: Female athletes develop low body weights. Approximately 4.3% of female athletes struggle with the female triad. The demands of athletes cause extensive stress and unhealthy eating patterns. About 62% of female athletes develop eating disorders. Conclusion & Nursing Implications: Nurses should be educated on how to identify symptoms, educate on risks associated with energy deficiency, and refer athletes to resources. It is important for nurses, coaches, and families to work to promote the health and well-being of athletes, and to prioritize prevention and early intervention when it comes to eating disorders. Key search terms: Search terms include “female athletes”, “the female triad”, “eating disorders”, “eating disorders in sports”, “coaches' role in the female triad”, and “risk for injuries”.

The purpose of this literature review was to identify differentiating risk factors in women for postpartum depression and postpartum psychosis. By understanding differentiating risk factors health care professionals, and nurses in particular, can be alert to women who are at higher risk for postpartum depression or postpartum psychosis. This information allows for early nursing intervention and the development of appropriate treatment plans. Fifteen peer-reviewed, English language research articles published between 2000 and 2015 were analyzed for the purpose of this literature review. Study results were inconclusive for the intention of this review, but do provide valuable information on independent risk factors for both disorders. A history of depression and significant life stressors are strong predictors for postpartum depression. Whereas a history of bipolar disorder is strongly associated with the development of postpartum psychosis. Further research is needed to examine the role of genetics in both postpartum depression and postpartum psychosis and to further evaluate risk factors for postpartum psychosis, specifically in women with no history of bipolar disorder. Moreover, additional research needs to be conducted within the United States due to a lack of generalizability of studies conducted in other nations.

The Rural Expansion Program for At-risk Communities to Promote Health Outcomes through the Integration of Mental health and Enabling services in an Existing Primary Care School-Based Setting (REACH ME) program was established to increase access to mental health services at two existing school-based health centers (SBHC) in rural Hancock County, TN. These SBHCs are among the most unique in the nation, holding designations as federally funded qualified health centers - proving primary care services in a geographically isolated, rural, and medically underserved area. The aim of the project is increasing the number of patients receiving mental health and enabling services for not only the children and adolescents of Hancock County, but also adults who use the clinic for primary care services. This project employs a secondary data analysis to determine if there is an increase in the use of mental health services by patients using a school-based health center for care. Variables include number of visits, screening employed, and mental health diagnosis. Data gathered by health center staff and input into Excel will be used. Data collection is ongoing and is expected to be completed in February 2024. Early results indicate an increase in mental health and enabling services from initiation of the project. There were identified facilitators and barriers that impacted the project. Significance for this project is two-fold, identified facilitators and barriers to initiating integrated mental health services in the SBHC setting and increasing early screening, identification, referral and treatment of rural populations with mental health problems.

Trauma informed care nursing education is crucial. Trauma informed care is a method of providing health care which understands the likelihood of past and present traumatic events in patients and families. The experience of past or present trauma often led to chronic diseases, substance abuse disorder, fragmented health care, fears surrounding health care, chronic stress, and other negative health consequences. The purpose of this project is to increase licensed nurses’ awareness and ability to practice trauma informed care in clinical practice, as well as promote policy initiation within the health care facilities. Method planning integrated the Knowledge to Action Cycle. A two hour, Delphi reviewed, evidenced based educational session was developed for licensed nurses in two health care facilities. After the educational session is completed, an anonymous survey will be distributed to determine the licensed nurses’ awareness of trauma informed care. A second anonymous survey will be sent four weeks later to assess changes in clinical practice based on trauma informed care education. One educational session for eleven licensed nurses working in a psychiatric facility has been completed. Two preliminary themes emerged from the first survey. The first theme was more intentional focus on integrating trauma informed care principles into practice. The second theme was an increased need for self-care. Two more educational sessions are planned for licensed nurses in an acute care hospital. Keywords: trauma informed care, nursing, education, KTA Cycle, health care, policy

Orientador: Elen Rose Lodeiro Castanheira / Resumo: Introdução: A temática do acesso vem ocupando espaço crescente nos debates da Atenção Primária à Saúde (APS) no Brasil, tendo diversos municípios e serviços isolados investido em novas modelagem de organização da demanda nos últimos anos. A operacionalização destas iniciativas e suas repercussões no processo de trabalho dos serviços e na qualidade do cuidado prestado ainda carecem de investigação. Objetivos: Descrever a implantação do Acolhimento por Equipe (AE), dispositivo de acesso idealizado e desenvolvido no município de São Bernardo do Campo-SP, bem como analisar as suas repercussões no processo de trabalho, ampliação do acesso e qualidade do cuidado prestado à população, segundo a perspectiva dos trabalhadores. Metodologia: Foi desenvolvido um estudo de caso qualitativo. A coleta de dados se deu a partir de doze entrevistas semiestruturadas realizadas em fevereiro de 2018. Foram eleitos como sujeitos da pesquisa os profissionais de nível superior que se encontravam vinculados às duas equipes pioneiras na implantação do AE. Estes sujeitos foram divididos em dois núcleos: um, aqui denominado ‘núcleo fundador’, que compreendia os profissionais que atuavam nas equipes em 2014 e outro, aqui chamado de ‘núcleo contemporâneo’, que compreendia os profissionais que atuavam nas equipes em 2018. Os dados foram tratados a partir dos referenciais teóricos da análise de conteúdo, de Laurence Bardin (2004) e do método hermenêutico-dialético, de Minayo (1994). Do tratamento de dados e... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

A literatura demonstra que a dimensão espiritual tem impacto na saúde biopsicossocial, sendo associada à preservação da saúde mental, qualidade de vida e redução da mortalidade global e cardiovascular. Contudo, são descritas várias barreiras para a abordagem clínica da espiritualidade do paciente, como a falta de tempo ou treinamento sobre o assunto, além dos valores pessoais e religiosos do profissional. A abordagem da espiritualidade na prática clínica de médicos de família e comunidade (MFC) ainda é um desafio e, com isso, a presente dissertação descreve aspectos da dimensão espiritual e religiosa de MFC brasileiros, com residência médica na área, além de apresentar aspectos sobre a inserção do tema da espiritualidade/religiosidade (E/R) na prática clínica desse grupo de profissionais. Para tanto, foi realizado um estudo observacional transversal por meio de questionário online. Os dados foram analisados quantitativamente por meio de medidas de frequência numérica, percentual e de tendência central. A frequência e temática abordadas pelos MFC em relação à E/R foram aferidas por meio de constructo que agregou os questionários FICA, HOPE e SPIRITual History. Os escores de bem-estar espiritual e religiosidade dos médicos foram aferidos por meio de escalas bem avaliadas na literatura (respectivamente, FACIT-SpNI e DUREL-P). O inquérito online obteve taxa de resposta de 15,8%, sendo a amostra de maioria do sexo feminino (65,1%), com idade média de 35,8 anos e média de tempo de trabalho na área de 7,9 anos. A atuação profissional se dá em assistência clínica (87,7%) e ensino (67,1%). A maioria (78,4%) declara identificação com uma matriz religiosa, sendo 21,6% católicos, 13,7% espíritas e 11,3% evangélicos. Grande parte da amostra (21,6%) se identificou com mais de uma religião. Os MFC apresentam baixa religiosidade organizacional (49,3% raramente ou nunca frequentam instituições), porém, forte prática de religiosidade não organizacional (65,4% declaram práticas pessoais no mínimo semanais). O escore de religiosidade intrínseca médio foi de 10,6 (padrão: 3 a 15) e o de bem-estar espiritual foi de 35,7 (padrão: 0-48). Para a prática clínica, houve maior concordância com o conceito de espiritualidade de Puchalski, que apresenta amplitude moderada quando comparado aos conceitos de Anandarajah e Koenig. O grau de concordância apontou no sentido de diferenciação do conceito de espiritualidade em relação à definição de religiosidade. Embora a grande maioria acredite que a E/R influencie muito a saúde (88,4%) e que essa abordagem seja pertinente à prática clínica do MFC (81,2%), apenas 35,0% da amostra se sentia preparada para abordar o tema e a maioria o faz com frequência moderada (50,3%). As principais barreiras para essa abordagem seriam falta de tempo (53,4%), treinamento (39,7%) e valores pessoais, como medo de impor sua religião (27,7%) ou medo de ofender o paciente (23,6%). As áreas mais frequentemente discutidas pelos MFC com os pacientes tratam da rede de suporte social (discutido por 42,8% dos médicos) e resiliência (40,2%). Os temas menos discutidos seriam a relação médico-paciente (não discutido por 74,0%) e as implicações para o plano terapêutico (64,7%) / Researches show that the spiritual dimension influences the biopsychosocial health, being associated with the preservation of mental health, quality of life and reduction of global and cardiovascular mortality. However, there are several barriers for approaching patient\'s spirituality in clinical practice, such as the lack of time or training on this subject and personal values of the professionals, as religiosity. Approaching spirituality is still a challenge for Brazilian Family Physicians (BFP). Then, the present research describes aspects of the spiritual and religious dimensions of Brazilian Family Physicians who had completed medical residency programs in this area. It also shows aspects about the insertion of spirituality/religiosity (S/R) in the clinical practice of this group of professionals. For this reason, we carried out a cross-observational study by means an online questionnaire. We analyzed the data quantitatively by means of simple distribution and frequency measurements. The frequency and thematic discussed by BFP in relation to S/R were measured by an instrument developed using the questionnaires FICA, HOPE and SPIRITual History. We evaluated the doctors\' scores of spiritual- wellbeing and religiosity by means of well-evaluated scales (respectively, FACIT-SpNI and Durel-P). The online survey obtained response rate of 15.8%. The sample had most female (65.1%), average age of 35.8 years-old and average working time in the area of 7.9 years. Most of the professionals works in clinical assistance (87.7%) and teaching (67.1%). The majority (78.4%) declares identification with one religion, being 21.6% Catholics, 13.7% Spiritists and 11.3% Protestants. A large portion of the sample (21.6%) identified itself with more than one religion. The BFP showed low organizational religiosity (49.3% rarely or never attend to institutions), but high practice of non-organizational religiosity (65.4% declare personal practices at least weekly). The average of intrinsic religiosity score was 10.6 (standard: 3-15) and the spiritual-wellbeing average score was 35.7 (standard: 0-48). About the clinical practice, there was greater agreement with the concept of spirituality carried out by Puchalski, which presents moderate amplitude when compared to Anandarajah\'s or Koenig\'s concepts. The concordance degree showed same tendency to the sense of differentiation of the concepts of spirituality and religiosity. While 88.4% of BFP believe that the S/R influences a lot the health and 81.2% believe that this approach is pertinent to their clinical practice, only 35.0% of the sample felt prepared to address this topic and most do it sometimes (50.3%). The main barriers to this approach were lack of time (53.4%), training (39.7%) and personal values, such as fear of imposing their religion (27.7%) or fear of offending the patient (23.6%). The themes most often discussed by BFP with patients deal with the social support network (discussed by 42.8% of doctors) and resilience (40.2%). The less discussed subjects were the doctor-patient relationship (not discussed by 74.0%) and the implications for the therapeutic plan (64.7%)

A aplicação das medidas preventivas, principalmente das doenças crônicas não transmissíveis (DCNT), tem sido debatida mundialmente, já que poucos fatores de risco respondem pela maioria das mortes por DCNT, como o tabagismo, alcoolismo, obesidade e dislipidemias. A sistematização das medidas de promoção de saúde e prevenção de doenças (PSPD) pode contribuir para o trabalho das equipes de Saúde da Família, potencializando as suas ações e fortalecendo a Atenção Primária à Saúde (APS). Face ao baixo registro das medidas de prevenção das DCNTs no Brasil e à ausência de parâmetros na literatura nacional, comparamos a percepção dos profissionais e o registro das medidas de PSPD dos centros de saúde brasileiros com os serviços espanhóis, considerados referência no assunto. Realizamos um estudo descritivo e quantitativo, por meio da aplicação de um questionário aos profissionais e da análise dos prontuários dos serviços de APS de municípios de pequeno, médio e grande porte do Brasil e da Espanha. Entrevistamos 82 profissionais entre médicos (50%) e enfermeiros (50%), com elevado grau de especialização (77,5%). A maioria dos espanhóis tinha mais de 10 anos de formado (73%), e 54% atuavam na APS há mais de 10 anos, ao contrário dos brasileiros (63,2%) com uma formação mais jovem (menos de 6 anos de formado) e alta rotatividade na APS. Quase metade dos entrevistados (47,6%) relatou que qualquer encontro com o usuário é adequado para prevenção, enquanto outros preferem a consulta agendada (43,9%), a visita domiciliar (22%) e os grupos (22%). Já 86,6% desaprovam a consulta eventual como local para prevenção. A medida mais empregada pelos profissionais entrevistados foi o aconselhamento, seguida da vacinação e do rastreamento entre brasileiros, para os espanhóis o rastreamento foi mais citado que a vacinação. Apesar do aconselhamento ter sido o mais citado, o rastreamento foi a medida mais registrada pelos serviços estudados. O aconselhamento teve mais registros nos prontuários brasileiros que nos espanhóis, e o inverso ocorreu com a vacinação. Apesar de todos concordarem que a prevenção é importante parte da assistência, estarem motivados (96%) e possuírem conhecimento para aplicá-lo (94%), houve um baixo percentual de registro do rastreamento de tabagismo, alcoolismo e vacinação nos dois países. No Brasil, encontramos um alto percentual de rastreamento em algumas medidas entre os usuários, porém, quando analisamos a cobertura populacional (5%), esse valor fica abaixo da média espanhola (25%). Segundo os espanhóis, os obstáculos para aplicar as medidas preventivas são a falta de tempo, orientações conflitantes das sociedades, falta de incentivo e outras prioridades. Já para os brasileiros, a falta de incentivo e de interesse, o desconhecimento e a presença de medidas conflitantes são os maiores desafios. Os obstáculos refletem as realidades distintas e a necessidade de investimento em diferentes áreas. No Brasil faz-se necessário investir na formação dos profissionais e em instrumentos que auxiliem a equipe na aplicação das ações preventivas, enquanto na Espanha é possível que a reorganização do serviço, principalmente quanto à administração do tempo e criação de recomendações consensuais entre as sociedades, favoreça a aplicação das medidas preventivas pelos profissionais. / The discussion on preventive measures, specially of non-transmissible chronic degenerative diseases (NTCD), is in vogue worldwide, as very few risk factors, such as smoking, alcoholism, obesity and dyslipidemia, are responsible for most of the deaths due to NTCD. The organization of the measures of health promotion and disease prevention (HPDP) would greatly contribute to the work of family practioners and strengthen primary care. Insufficient documentation on the screening of NTCD in Brazil and the paucity of international parameters of comparison, stimulated us to evaluate the opinions of and documentation by healthcare workers in primary care, of the HPDP measures in Brazil compared to those in Spain, considered by many as a reference in this matter. A descriptive, quantitative study was undertaken by analysing a questionnaire filled out by healthcare workers as well as the primary care documentation of HPDP measures in small, medium and large municipalities in Brazil and Spain. Eighty two healthcare workers responded to the questionnaire, which included doctors (50%) and nurses (50%), most of whom were specialized in their respective fields (77.5%). Most of the workers in Spain had graduated more than 10 years earlier (73%) and have been working in primary care for more than 10 years (54%), while in Brazil most of the workers had graduated less than 6 years earlier (63.2%) with correspondingly lesser time in primary care. Almost half of the healthcare workers consider any encounter with the clients as adequate for implementing preventive measures(47.6%), while others prefered routine consultations (43.9%), house calls (22%) or group meetings (22%). Unplanned or emergency consultation was considered an inappropriate moment for implementing preventive measures by 86.6%. The most commonly employed measure according to the questionnaires in Brazil, is counselling, followed by vaccination and screening, while the Spanish reported screening more often than vaccination. In spite of counselling being considered the most frequently applied measure, screening was most frequently documented. Counselling was the most documented measure in Brazil, while vaccination was in Spain. Although everyone agreed that prevention is an important part of primary care, with enough motivation (96%) and knowledge (94%) to apply them, the documentation of screening for smoking, alcoholism and vaccination was low in both countries. In Brazil, although we found a high percentage of screening among those who were seen in the primary care units, when we considered the coverage of the area under the respective units, this percentage (5%) is very much below the Spanish average (25%). The barriers to the application of preventive measures in Spain were reported to be the lack of time, conflicting guidelines, lack of incentive and other priorities. While in Brazil, the lack of interest, incentive, knowledge as well conflicting guidelines were considered the main barriers. These barriers reflect the different realities and consequently need different investments. Brazil needs to invest in human resources and the development of instruments to help the primary care personnel in implementing preventive measures. While in Spain, its possible that better time management and more consensual recommendations could favor the applications of these measures in primary care.

L’automesure tensionnelle (AMT) est recommandée par toutes les Sociétés Savantes pour le diagnostic et le suivi des patients hypertendus. Après une revue de la littérature en 2013, concernant les avantages diagnostiques, thérapeutiques et pronostiques de l’AMT, nous avons comparé les similitudes et les différences existant entre les différentes recommandations. Nous avons discuté les limites de l’AMT, en la comparant aux mesures cliniques et à la mesure ambulatoire de la pression artérielle sur 24h. L’implémentation de l’AMT par les Médecins Généralistes (MG) Français est médiocre. Si sa pratique est plus fréquente parmi les MG Grecs, ceux-ci sont très critiques envers la qualité des données. Les AMT doivent être réalisées en suivant une méthodologie comprenant un repos préalable avant de pratiquer les mesures. Nous avons montré que ce repos n’est en fait que rarement respecté par les patients, et qu’il est peut-être inutile. / Home Blood Pressure Measurement (HBPM) is recommended by all guidelines for the diagnosis and follow-up of hypertensive patients. After a 2013 literature review, concerning diagnostic, therapeutic and prognostic benefits, we compared similarities and differences between guidelines. We discussed HBPM limits, comparing HBPM with casual office measurements and 24h Ambulatory Blood Pressure Measurements. HBPM implementation among French General Practitioners (GP) is poor. In Greece, GPs more often practice HBPM but reported drawbacks were questionable about reliability of patients’ reports and devices inaccuracy. Guidelines recommend following a precise protocol including rest before HBPM. We showed that rest is not respected by the patients in the real life, and is perhaps unnecessary.