INTRODUÇÃO: O aborto em consequência do abuso sexual é permitido na legislação brasileira, porém não significa que exista um consenso sobre esse tema na nossa sociedade. O nosso questionamento foi, sobretudo, o livre arbítrio da mulher em decidir sobre a interrupção da gestação frente a esse direito que lhe é concedido e o impacto do abuso sexual na vida dessa mulher. Utilizamos dos conceitos basilares da bioética para fundamentar a problemática referente ao inicio da vida, bem como do principio da autonomia do ser humano diante da escolha. O sujeito que iremos nos deter é a mulher que um dia foi vitima de um delito e em outro momento se tornou uma criminosa. MÉTODOS: A pesquisa foi realizada na Penitenciaria de Piraquara no Estado do Paraná, Brasil. A seleção foi feita na escola da penitenciaria, no programa de educação de jovens e adultos. Após a seleção dos sujeitos, realizamos uma entrevista a partir de um roteiro semiestruturado. A analise qualitativa foi realizada a partir de uma analise temática. RESULTADOS: Tivemos em nossa amostra 65 sujeitos sendo que 50 responderam não terem sofrido abuso sexual e 15 responderam afirmativamente a essa questão. Isso representa que 23 % da população estudada foram abusadas sexualmente. E desses 15 sujeitos que sofreram abuso sexual 4 afirmaram procuraram o serviço de saúde e forma orientadas sobre os procedimentos para prevenir a gestação e doenças sexualmente transmissíveis. Realizamos a entrevista e na analise temática abordamos os seguintes tópicos: (1) o episodio da violência sexual, (2) momento da vida em que ocorreu, (3) se procurou ajuda , (4) se conhece o agressor , (5) se ficou gravida e se interrompeu a gestação decorrente do abuso sexual. CONCLUSÃO: A amostra estudada não representa todos os seguimentos sociais, uma vez que a pesquisa foi realizada com a população carcerária feminina. A interrupção da gestação em consequência do abuso sexual passa a ser um assunto secundário frente ao abuso sexual. Ocorreu um consenso entre todas as entrevistadas que o abuso sexual deixa marcas para sempre e que caso ocorresse uma gravidez fruto desse abuso iriam interromper / INTRODUCTION: Abortion as a consequence of sexual abuse is accepted by the Brazilian legislation. However, that does not mean that there is a consensus on the issue in our society. Our question was, above all, women\'s free will to decide upon interrupting her pregnancy, as this right is granted to her, as well as the impact of sexual abuse in their lives. We used bioethics concepts to as the base for the problem related to the beginning of their life, as well as the principle of human autonomy when facing a choice. The subject who we will analyze is the woman who, one day, was the victim of abuse and, in another moment, became a criminal, and started dealing drugs. METHODS: The study was carried out in the Piraquara Penitentiary in the state of Paraná, Brazil. Selection was carried out in the penitentiary school, in the education program for adults and young adults. After subjects were selected, they were interviewed using a semi-structured questionnaire. The qualitative study was performed by thematic analysis. RESULTS: There were 65 subjects in our sample, and 50 of them said they had not suffered sexual abuse; 15 stated they had, represented 23% of the population studied. From these 15 subjects who suffered sexual abuse, four stated they had sought the health services and were informed about the procedures to prevent pregnancy and sexually transmitted diseases. We carried out the interview and the thematic analysis on the following topics: (1) episode of sexual abuse; (2) moment of life when this occurred; (3) if they looked for help; (4) if they knew the abuser; (5) if she got pregnant and if they interrupted the pregnancy caused by sexual abuse. CONCLUSION: The sample analyzed does not represent all social segments, once the study was carried out among female prisoners in a women\'s penitentiary. Interruption of pregnancy as a consequence of abuse becomes a secondary issue when sexual abuse is considered. There was a consensus among the interviewees that sexual abuse marks the person for life, and that they would interrupt pregnancy if it was a result of the abuse.

INTRODUÇÃO: O aborto em consequência do abuso sexual é permitido na legislação brasileira, porém não significa que exista um consenso sobre esse tema na nossa sociedade. O nosso questionamento foi, sobretudo, o livre arbítrio da mulher em decidir sobre a interrupção da gestação frente a esse direito que lhe é concedido e o impacto do abuso sexual na vida dessa mulher. Utilizamos dos conceitos basilares da bioética para fundamentar a problemática referente ao inicio da vida, bem como do principio da autonomia do ser humano diante da escolha. O sujeito que iremos nos deter é a mulher que um dia foi vitima de um delito e em outro momento se tornou uma criminosa. MÉTODOS: A pesquisa foi realizada na Penitenciaria de Piraquara no Estado do Paraná, Brasil. A seleção foi feita na escola da penitenciaria, no programa de educação de jovens e adultos. Após a seleção dos sujeitos, realizamos uma entrevista a partir de um roteiro semiestruturado. A analise qualitativa foi realizada a partir de uma analise temática. RESULTADOS: Tivemos em nossa amostra 65 sujeitos sendo que 50 responderam não terem sofrido abuso sexual e 15 responderam afirmativamente a essa questão. Isso representa que 23 % da população estudada foram abusadas sexualmente. E desses 15 sujeitos que sofreram abuso sexual 4 afirmaram procuraram o serviço de saúde e forma orientadas sobre os procedimentos para prevenir a gestação e doenças sexualmente transmissíveis. Realizamos a entrevista e na analise temática abordamos os seguintes tópicos: (1) o episodio da violência sexual, (2) momento da vida em que ocorreu, (3) se procurou ajuda , (4) se conhece o agressor , (5) se ficou gravida e se interrompeu a gestação decorrente do abuso sexual. CONCLUSÃO: A amostra estudada não representa todos os seguimentos sociais, uma vez que a pesquisa foi realizada com a população carcerária feminina. A interrupção da gestação em consequência do abuso sexual passa a ser um assunto secundário frente ao abuso sexual. Ocorreu um consenso entre todas as entrevistadas que o abuso sexual deixa marcas para sempre e que caso ocorresse uma gravidez fruto desse abuso iriam interromper / INTRODUCTION: Abortion as a consequence of sexual abuse is accepted by the Brazilian legislation. However, that does not mean that there is a consensus on the issue in our society. Our question was, above all, women\'s free will to decide upon interrupting her pregnancy, as this right is granted to her, as well as the impact of sexual abuse in their lives. We used bioethics concepts to as the base for the problem related to the beginning of their life, as well as the principle of human autonomy when facing a choice. The subject who we will analyze is the woman who, one day, was the victim of abuse and, in another moment, became a criminal, and started dealing drugs. METHODS: The study was carried out in the Piraquara Penitentiary in the state of Paraná, Brazil. Selection was carried out in the penitentiary school, in the education program for adults and young adults. After subjects were selected, they were interviewed using a semi-structured questionnaire. The qualitative study was performed by thematic analysis. RESULTS: There were 65 subjects in our sample, and 50 of them said they had not suffered sexual abuse; 15 stated they had, represented 23% of the population studied. From these 15 subjects who suffered sexual abuse, four stated they had sought the health services and were informed about the procedures to prevent pregnancy and sexually transmitted diseases. We carried out the interview and the thematic analysis on the following topics: (1) episode of sexual abuse; (2) moment of life when this occurred; (3) if they looked for help; (4) if they knew the abuser; (5) if she got pregnant and if they interrupted the pregnancy caused by sexual abuse. CONCLUSION: The sample analyzed does not represent all social segments, once the study was carried out among female prisoners in a women\'s penitentiary. Interruption of pregnancy as a consequence of abuse becomes a secondary issue when sexual abuse is considered. There was a consensus among the interviewees that sexual abuse marks the person for life, and that they would interrupt pregnancy if it was a result of the abuse.

AIM: To examine the safety and acceptability of providing antiretroviral therapy (ART) in a resource poor setting. DESIGN: Two-stage observational and qualitative study. SETTING: Rural hospital in Southern Africa. METHODS: Structured observation using failure modes and effects analysis (FMEA) of the drug supply, dispensing, prescribing and administration processes. The findings from the FMEA were explored further in qualitative interviews with eight health professionals involved in the delivery of ART. To obtain a patient perspective, a stratified sample of 14 patients receiving ART was also interviewed. RESULTS: Key vulnerabilities in the process of ART provision include supply problems, poor packaging and labelling, inadequate knowledge among staff and lack of staff. Key barriers to successful patient adherence include transport inconsistency in supply and personal financial difficulties. There is, however, strong evidence of patient commitment and adherence. IMPLICATIONS AND CONCLUSION: Medication safety is relatively unexplored in the developing world. This study reveals an encouraging resilience in the health system and adherence among patients in the delivery of complex ART. The vulnerabilities identified, however, undermine patient safety and effectiveness of ART. There are implications for drug manufacturers; international aid agencies funding and supplying ART; and local practitioners. FMEA can help identify potential vulnerabilities and inform safety improvement interventions.

The widely acknowledged doctor shortage in Canada has recently motivated a more critical look at the licensure rates of International Medical Doctors (IMDs), also known as International Medical Graduates (IMGs). However, very little research has been conducted on the experiences of IMDs before they enter the Canadian medical system. This qualitative study collected interview data from 15 diverse IMDs seeking licensure in Ontario, Canada. The participants varied with respect to age, country of origin, English language proficiency on arrival, and time in Canada. In addition, two bridging support programs were observed, and interviews were conducted with three educators from the programs. The interviews were analysed using thematic content analysis (Boyatzis, 1998; Miles & Huberman, 1994). An analysis of metaphors used by the IMDs to describe their experiences during the licensing process supported the use of poetic representation for key findings, resulting in three poems that are interspersed in the body of the thesis (Ellingson, 2011; Glesne, 1997; Richardson, 2002; Richardson & Adams St. Pierre, 2005). The theoretical framework of the research was informed by Vygotskian Sociocultural Theory, which views learning as inseparable from social interaction and context (Vygotsky, 1987). Third-generation Activity Theory (AT), which has descended from Vygotsky’s work, was applied to highlight the higher-level systemic issues related to medical licensing. Results of this study indicate that IMDs with lower English proficiency face substantial difficulties on arrival, with limited access to the type of medically-relevant language instruction needed to support them. In fact, all pre-licensure IMDs struggle to access the interactional learning opportunities (i.e., Vygotskian “mediational means”) to support their entry into the system. Licensing challenges include limited exam preparation resources that support acquisition of Canadian cultural content; unequal access to clinical observerships; and a selection process which lacks transparency and emphasizes a screening tool unfamiliar to IMDs, the residency interview. Implications of this study include the revisiting of immigration policy; increasing the transparency and effectiveness of the selection process/residency interview; reviewing the role of clinical observerships in the selection process and exploring the potential of observerships to function as a licensure portfolio assessment.

The widely acknowledged doctor shortage in Canada has recently motivated a more critical look at the licensure rates of International Medical Doctors (IMDs), also known as International Medical Graduates (IMGs). However, very little research has been conducted on the experiences of IMDs before they enter the Canadian medical system. This qualitative study collected interview data from 15 diverse IMDs seeking licensure in Ontario, Canada. The participants varied with respect to age, country of origin, English language proficiency on arrival, and time in Canada. In addition, two bridging support programs were observed, and interviews were conducted with three educators from the programs. The interviews were analysed using thematic content analysis (Boyatzis, 1998; Miles & Huberman, 1994). An analysis of metaphors used by the IMDs to describe their experiences during the licensing process supported the use of poetic representation for key findings, resulting in three poems that are interspersed in the body of the thesis (Ellingson, 2011; Glesne, 1997; Richardson, 2002; Richardson & Adams St. Pierre, 2005). The theoretical framework of the research was informed by Vygotskian Sociocultural Theory, which views learning as inseparable from social interaction and context (Vygotsky, 1987). Third-generation Activity Theory (AT), which has descended from Vygotsky’s work, was applied to highlight the higher-level systemic issues related to medical licensing. Results of this study indicate that IMDs with lower English proficiency face substantial difficulties on arrival, with limited access to the type of medically-relevant language instruction needed to support them. In fact, all pre-licensure IMDs struggle to access the interactional learning opportunities (i.e., Vygotskian “mediational means”) to support their entry into the system. Licensing challenges include limited exam preparation resources that support acquisition of Canadian cultural content; unequal access to clinical observerships; and a selection process which lacks transparency and emphasizes a screening tool unfamiliar to IMDs, the residency interview. Implications of this study include the revisiting of immigration policy; increasing the transparency and effectiveness of the selection process/residency interview; reviewing the role of clinical observerships in the selection process and exploring the potential of observerships to function as a licensure portfolio assessment.

Introdução: O AVC (acidente vascular cerebral) é uma das mais importantes causas de alterações neuropsicológicas. Uma avaliação cognitiva inicial realizada por telefone implicaria em um diagnóstico mais precoce de prejuízo cognitivo e demência, reduzindo custos e tempo. Objetivo: Examinar as propriedades psicométricas da versão brasileira da Entrevista Telefônica para Avaliação do Estado Cognitivo - Modificada (TICS-M) em pacientes pós-AVC. Métodos: Previamente à validação da TICS-M em indivíduos acometidos por AVC, foi realizada tradução para o Português do Brasil e adaptação transcultural da versão original da TICS-M em uma amostra de 30 sujeitos não clínicos. Após esta fase, um subgrupo de 61 pacientes com AVC, participantes do Estudo da Mortalidade e Morbidade do AVC (EMMA) que ocorre no Hospital Universitário da Universidade de São Paulo, foram convidados a participar da validação da TICS-M, seis meses após o evento agudo. A TICS-M foi aplicada em três momentos: avaliação inicial (entrevista presencial), uma e duas semanas após a primeira avaliação. Na avaliação inicial, além da TICS-M, questionários adicionais foram aplicados para avaliar a cognição: MoCA (Montreal Cognitive Assessment), MEEM (Mini Exame do Estado Mental); e para a depressão, HDRS (Hamilton Depression Rating Scale). Todos os questionários foram aplicados por duas entrevistadoras treinadas para o estudo. A confiabilidade intra-observador da TICS-M foi testada através dos coeficientes de Pearson, Intraclasse e alfa de Cronbach. As características internas do TICS-M também foram avaliadas através de uma análise exploratória utilizando o método Análise de Componentes Principais. A validade discriminatória do instrumento para rastreamento de demência pós-AVC foi avaliada em comparação a MEEM pela análise da área sob a curva (AUC) determinada pela curva ROC. Foram calculadas sensibilidade e especificidade para o ponto de corte ideal para rastrear demência. Resultados: De maneira geral, a TICS-M traduzida para o português apresentou um bom entendimento dos itens na mostra de indivíduos não clínicos. Foi observada uma frequência de 23% sugestiva de demência pós-AVC. O nível de escolaridade esteve positivamente associado ao estado demencial rastreado pelo MEEM. O estado depressivo assim como outras características de base não se associou à demência sugerida pelo MEEM. A confiabilidade teste-reteste intra-observador revelou taxas quase totais nos três momentos avaliados (Pearson Coeficiente > 0,85, Coeficientes de Correlação Intraclasse > 0,85 e Coeficiente alfa de Cronbach: 0,96). A análise fatorial determinou três domínios: memória de trabalho e atenção; memória recente e de evocação e orientação. A área sob a curva (AUC) determinada para a TICS-M em comparação com MEEM foi de 0,89 (intervalo de confiança 95%: 0,80-0,98). O ponto de corte sugerido para TICS-M foi de 14 pontos (escala de 0-39 pontos) para rastrear demência com sensibilidade de 91,5% e especificidade de 71,4%. Resultados semelhantes foram observadas com o MoCA. Conclusão: A versão brasileira da TICS-M sugere ser um instrumento de pesquisa útil e confiável para rastrear demência em pacientes pós-AVC / Introduction: Stroke is one most important cause of neuropsychological disorders. An initial cognitive assessment performed by telephone resulting in an early diagnosis of cognitive impairment and dementia, reducing costs and time. Objective: To examine the psychometric properties of the Brazilian version of the Modified Telephone Interview for Cognitive Status Assessment (TICS-M) for assessment of dementia in post-stroke patients. Methods: Prior to validation of TICS-M in post-stroke patients, translation was performed for the Brazilian-Portuguese and cross-cultural adaptation of the original version of TICS-M in a non-clinical sample of 30 subjects. After this phase, 61 stroke patients enrolled in the Stroke Mortality and Morbidity Study (The EMMA study) that occurs at the University Hospital of the University of São Paulo, were invited to participate in this sub-study to validate the TICS-M six months after the acute event. The TICS-M was applied in three moments: first evaluation (personal interview), one and two weeks after of the first evaluation. At the first evaluation, beyond the TICS-M, additional questionnaires were applied to assess cognition: MoCA (Montreal Cognitive Assessment), MMSE (Mini-Mental Status Examination), and for depression, HDRS (Hamilton Depression Rating Scale). All questionnaires were administered by two trained interviewers for the study. Reliability of the TICS-M was tested by intra-observer rates using Pearson, Intraclass and Cronbach´s alpha coefficients. The internal characteristics of TICS-M were also evaluated by an exploratory analysis using Principal Component Analysis. The discrimination validity of the instrument to assess dementia was evaluated by comparison to the MMSE analysis of the area under the curve (AUC) determined by the ROC curve. Sensitivity and specificity for the ideal cutoff to assess dementia were calculated. Results: In general, the TICS-M translated into Portuguese version showed a good understanding of the items in non-clinical individuals. A frequency of 23% suggestive of post-stroke dementia was observed. The level of education was positively associated with dementia status assessed by MMSE. The depressive status, as well as, other baseline characteristics was not associated with dementia suggested by MMSE. Test-retest reliability intra-observer revealed almost total rates in the three evaluation moments (Pearson coefficient > 0.85, Intraclass Correlation Coefficient > 0.85 and Cronbach\'s alpha coefficient: 0.96). The factorial analysis determined three domains: working memory and attention, recent and recall memory and orientation. The area under the curve (AUC) determined by TICS-M compared to MMSE was 0.89 (95% confidence interval: 0.80-0.98). The cutoff suggested for TICS-M was equal or greater than 14 points (range 0-39 points) to assess dementia (91.5% sensitivity, 71.4 % specificity). Similar results were observed with the MoCA. Conclusion: The Brazilian version of TICSM suggests being a useful and reliable research instrument to evaluate dementia in poststroke patients in epidemiological studies

Introdução: O AVC (acidente vascular cerebral) é uma das mais importantes causas de alterações neuropsicológicas. Uma avaliação cognitiva inicial realizada por telefone implicaria em um diagnóstico mais precoce de prejuízo cognitivo e demência, reduzindo custos e tempo. Objetivo: Examinar as propriedades psicométricas da versão brasileira da Entrevista Telefônica para Avaliação do Estado Cognitivo - Modificada (TICS-M) em pacientes pós-AVC. Métodos: Previamente à validação da TICS-M em indivíduos acometidos por AVC, foi realizada tradução para o Português do Brasil e adaptação transcultural da versão original da TICS-M em uma amostra de 30 sujeitos não clínicos. Após esta fase, um subgrupo de 61 pacientes com AVC, participantes do Estudo da Mortalidade e Morbidade do AVC (EMMA) que ocorre no Hospital Universitário da Universidade de São Paulo, foram convidados a participar da validação da TICS-M, seis meses após o evento agudo. A TICS-M foi aplicada em três momentos: avaliação inicial (entrevista presencial), uma e duas semanas após a primeira avaliação. Na avaliação inicial, além da TICS-M, questionários adicionais foram aplicados para avaliar a cognição: MoCA (Montreal Cognitive Assessment), MEEM (Mini Exame do Estado Mental); e para a depressão, HDRS (Hamilton Depression Rating Scale). Todos os questionários foram aplicados por duas entrevistadoras treinadas para o estudo. A confiabilidade intra-observador da TICS-M foi testada através dos coeficientes de Pearson, Intraclasse e alfa de Cronbach. As características internas do TICS-M também foram avaliadas através de uma análise exploratória utilizando o método Análise de Componentes Principais. A validade discriminatória do instrumento para rastreamento de demência pós-AVC foi avaliada em comparação a MEEM pela análise da área sob a curva (AUC) determinada pela curva ROC. Foram calculadas sensibilidade e especificidade para o ponto de corte ideal para rastrear demência. Resultados: De maneira geral, a TICS-M traduzida para o português apresentou um bom entendimento dos itens na mostra de indivíduos não clínicos. Foi observada uma frequência de 23% sugestiva de demência pós-AVC. O nível de escolaridade esteve positivamente associado ao estado demencial rastreado pelo MEEM. O estado depressivo assim como outras características de base não se associou à demência sugerida pelo MEEM. A confiabilidade teste-reteste intra-observador revelou taxas quase totais nos três momentos avaliados (Pearson Coeficiente > 0,85, Coeficientes de Correlação Intraclasse > 0,85 e Coeficiente alfa de Cronbach: 0,96). A análise fatorial determinou três domínios: memória de trabalho e atenção; memória recente e de evocação e orientação. A área sob a curva (AUC) determinada para a TICS-M em comparação com MEEM foi de 0,89 (intervalo de confiança 95%: 0,80-0,98). O ponto de corte sugerido para TICS-M foi de 14 pontos (escala de 0-39 pontos) para rastrear demência com sensibilidade de 91,5% e especificidade de 71,4%. Resultados semelhantes foram observadas com o MoCA. Conclusão: A versão brasileira da TICS-M sugere ser um instrumento de pesquisa útil e confiável para rastrear demência em pacientes pós-AVC / Introduction: Stroke is one most important cause of neuropsychological disorders. An initial cognitive assessment performed by telephone resulting in an early diagnosis of cognitive impairment and dementia, reducing costs and time. Objective: To examine the psychometric properties of the Brazilian version of the Modified Telephone Interview for Cognitive Status Assessment (TICS-M) for assessment of dementia in post-stroke patients. Methods: Prior to validation of TICS-M in post-stroke patients, translation was performed for the Brazilian-Portuguese and cross-cultural adaptation of the original version of TICS-M in a non-clinical sample of 30 subjects. After this phase, 61 stroke patients enrolled in the Stroke Mortality and Morbidity Study (The EMMA study) that occurs at the University Hospital of the University of São Paulo, were invited to participate in this sub-study to validate the TICS-M six months after the acute event. The TICS-M was applied in three moments: first evaluation (personal interview), one and two weeks after of the first evaluation. At the first evaluation, beyond the TICS-M, additional questionnaires were applied to assess cognition: MoCA (Montreal Cognitive Assessment), MMSE (Mini-Mental Status Examination), and for depression, HDRS (Hamilton Depression Rating Scale). All questionnaires were administered by two trained interviewers for the study. Reliability of the TICS-M was tested by intra-observer rates using Pearson, Intraclass and Cronbach´s alpha coefficients. The internal characteristics of TICS-M were also evaluated by an exploratory analysis using Principal Component Analysis. The discrimination validity of the instrument to assess dementia was evaluated by comparison to the MMSE analysis of the area under the curve (AUC) determined by the ROC curve. Sensitivity and specificity for the ideal cutoff to assess dementia were calculated. Results: In general, the TICS-M translated into Portuguese version showed a good understanding of the items in non-clinical individuals. A frequency of 23% suggestive of post-stroke dementia was observed. The level of education was positively associated with dementia status assessed by MMSE. The depressive status, as well as, other baseline characteristics was not associated with dementia suggested by MMSE. Test-retest reliability intra-observer revealed almost total rates in the three evaluation moments (Pearson coefficient > 0.85, Intraclass Correlation Coefficient > 0.85 and Cronbach\'s alpha coefficient: 0.96). The factorial analysis determined three domains: working memory and attention, recent and recall memory and orientation. The area under the curve (AUC) determined by TICS-M compared to MMSE was 0.89 (95% confidence interval: 0.80-0.98). The cutoff suggested for TICS-M was equal or greater than 14 points (range 0-39 points) to assess dementia (91.5% sensitivity, 71.4 % specificity). Similar results were observed with the MoCA. Conclusion: The Brazilian version of TICSM suggests being a useful and reliable research instrument to evaluate dementia in poststroke patients in epidemiological studies