A visita domiciliar na formação de médicos: da concepção ao desafio do fazer

Desde 2003, desenvolve-se a Interação Universidade Serviço Comunidade (IUSC) na graduação médica de uma universidade pública do interior de São Paulo, Brasil, a partir da necessidade de vivências na Atenção Primária, visando à integralidade do cuidado. A visita domiciliar (VD) destacou-se como possibilidade para o estudante refletir sobre determinantes sociais do processo saúde-doença; desenvolver habilidades comunicacionais, prática educativa dialógica e vínculo com a comunidade; ampliar o raciocínio clínico e contribuir para a compreensão e resolução dos problemas familiares. O objetivo deste estudo foi investigar essa proposta da VD na formação médica, utilizando pesquisa documental. Contextualizou-se o desenvolvimento da VD na IUSC, sua importância, abrangência e desafios para sua legitimação e incorporação como prática pertinente à formação médica. Concluiu-se que a VD pode fortalecer e ampliar vínculos, compromissos, e favorecer a comunicação, contribuindo para a mudança da educação médica no Brasil.

Trabalhando com estratégias de ensino-aprendizado por descoberta na área da saúde: a problematização e a aprendizagem baseada em problemas.

Considering the changes in teaching in the health field and the demand for new ways of dealing with knowledge in higher learning, the article discusses two innovative methodological approaches: problem-based learning (PBL) and problematization. Describing the two methods' theoretical roots, the article attempts to identify their main foundations. As distinct proposals, both contribute to a review of the teaching and learning process: problematization, focused on knowledge construction in the context of the formation of a critical awareness; PBL, focused on cognitive aspects in the construction of concepts and appropriation of basic mechanisms in science. Both problematization and PBL lead to breaks with the traditional way of teaching and learning, stimulating participatory management by actors in the experience and reorganization of the relationship between theory and practice. The critique of each proposal's possibilities and limits using the analysis of their theoretical and methodological foundations leads us to conclude that pedagogical experiences based on PBL and/or problematization can represent an innovative trend in the context of health education, fostering breaks and more sweeping changes.

Pediatras e os distúrbios respiratórios do sono na criança

OBJECTIVES. assessment of opinions and practices of pediatricians concerning sleep-disordered breathing (SDB) in children. Methods. randomly 516 pediatricians were selected in the state of São Paulo, Brazil. A survey mailed to them included questions regarding: their professional profile, knowledge about SDB in childhood, opinions and practices for diagnosis and treatment of these diseases. RESULTS. 112 anonymous completed surveys were returned (21.7%). The teaching of SDB during medical school and pediatric residency training was considered unsatisfactory respectively by 65.2% and 34.8% of the pediatricians. Forty-nine respondents (43.8%) rated their knowledge about SDB in children as regular, 39 (34.8%) as good and 17 (15.2%) as unsatisfactory. The most important sleep-related questions were: mouth breathing, breathing pauses, sleep amount, excessive daytime sleepiness and nocturnal wheezing. Clinical aspects regarded as the most significant for suspecting obstructive sleep apnea syndrome (OSAS) were: breathing pauses, adenoid hypertrophy, mouth breathing, craniofacial anomaly and snoring. The most frequent practices for evaluation of OSAS in children were: cavum radiography with referral to an otorhinolarnygologist (25%) and nocturnal pulse oximetry (14.2%). Only 11.6% of pediatricians recommended overnight polysomnography and 4.5%, nap polysomnography. The most effective practices for SDB were considered to be: adenoidectomy and adenotonsillectomy, parents counseling, weight loss and sleep hygiene. CONCLUSIONS. there is a gap between research on SDB in childhood and pediatric practice. © 2006 Associação Médica Brasileira.

Produção científica na faculdade de filosofia, ciencias e letras de ribeirao preto-usp: Apliçãcao do índice de hirsch

In this work, an analysis of scientific bibliographic productivity was made using the Faculdade de Filosofia, Ciencias e Letras de Ribeirao Preto, Universidade de Sao Paulo (FFCLRP-USP) as example. It is a special Institution in the Brazilian University system which encompasses four important areas of knowledge (fields of concentration) in natural, biological, humanities, and social areas. It is composed by four departments which offer altogether eight undergraduate courses: 1) Psychology, 2) Pedagogy, 3) Chemistry, 4) Biology, 5) Medical Physics, 6) Biomedical Informatics, 7) Sciences of Information and Documentation and 8) Mathematics Applied to Business and six graduate programs leading to M.S. and Ph.D. degrees. Moreover, when analyzing the different courses of FFCLRP, they represent typical academic organization in Brazil and Latin America and could be taken as a model for analyzing other Brazilian research institutions. This analysis was made using: 1) the total number of papers (indexed in Curriculum Lattes database), 2) the number of papers indexed by Thomson ISI Web of Science database, and 3) the Hirsch (h-index). Bibliometric evaluations of undergraduate courses showed a better performance of the courses of Chemistry (P < 0.05), Biology (P < 0.05) and Medical Physics (P < 0.05) when compared to the Pedagogy, Sciences of Information and Documentation (P < 0.05) and Psychology (P < 0.05). We also analyzed the scientific output of the six graduate programs of FFCLRP-USP: 1) Chemistry, 2) Physics Applied to Medicine and Biology, 3) Entomology, 4) Compared Biology, 5) Psychology, 6) Psychobiology. The graduate programs in Psychobiology, Chemistry, Physics Applied to Medicine and Biology, Compared Biology, and Entomology presented very similar results, concerning the assessment of the three indexes. The graduate program in Psychology presented a lower h-index (P < 0.05) and had fewer papers indexed by the ISI (P < 0.05) when compared to the other graduate programs. The worse performance of the psychology program, pedagogy, sciences of information and documentation, psychology courses may be associated to the limited coverage of ISI database and some particular characteristics of this field of concentration.

Globalización, integración y cohesión social: el caso MERCOSUR

Incluye Bibliografía

Millennium development goals: progress towards the right to health in Latin america and the Caribbean

Includes bibliography

Integración económica y cohesión social: lecciones aprendidas y perspectivas

Incluye Bibliografía

La importancia de la cohesión social en la inserción internacional de América Latina

Incluye Bibliografía

El financiamiento solidario de la protección social: condición indispensable para un pacto de cohesión social en América Latina

Incluye Bibliografía

Por un contrato de cohesión social": apuntes exploratorios"

Incluye Bibliografía

Globalización, integración y cohesión social: el caso MERCOSUR

Incluye Bibliografía

A summary of the ECLAC proposals

Includes bibliography

ECLAC and the sociology of development

Includes bibliography

Moral judgment competence of medical students: a transcultural study

The authors conducted a cross-sectional short-term study using Lind's Moral Judgment Test (MJT) to compare moral judgment competence (C-score) among students from a medical school in the Northeast region of Brazil and a medical school in the Northern region of Portugal. This study compares the C-scores of groups in the first and eighth semesters of study within each medical school and groups from corresponding semesters between the two medical schools. This study also evaluates the influence of such factors as age and gender on moral competence. A regression of moral judgment competence among the students in their eighth semester versus the students in the first semester of Brazilian medical school (p < 0.001) and a stagnation of moral competence among students in their eighth semester versus the first semester students in the Portuguese medical school (p = 0.06) were observed. For both the first semester and eighth semester groups, the students in the Portuguese medical school had higher C-scores than the students in the Brazilian medical school. In the analysis of the students' performances in terms of MJT dilemmas, the phenomenon of moral segmentation was observed in all of the groups, and the students performed better on the worker's dilemma than on the doctor's dilemma. Among students in the same semester of study, older students had lower C-scores. There was generally no significant difference between men's and women's C-scores. © 2013 Springer Science+Business Media Dordrecht.

Acquisition of suture skills during medical graduation by instructor-directed training: A randomized controlled study comparing senior medical students and faculty surgeons

Due to shortage of time and limited availability of faculty surgeons to teach basic surgical skills during medical graduation, the search for alternative ways of simulated training with feedback is needed. The purpose of this study was to compare the simulated teaching of suture skills to novice medical students by senior medical students and by experienced faculty surgeons. Forty-eight novice medical students were randomly assigned to three practice conditions on bench model (n = 16): self-directed suture training (control), senior medical student-directed suture skills' training, or experienced faculty surgeon-directed suture skills' training. Pre- and post-tests were applied. Global Rating Scale with blinded evaluation and self-perceived confidence based on Likert scale were used to assess all suture performances in pre- and post-training. Effect size was also calculated. The analysis made after training showed that the students who received feedback from the instructors had better performance based on the Global Rating Scale (all p < 0.0000) and felt more confident to carry out sutures (all p < 0.0000) when compared to the control. There was no significant difference (all p > 0.05) between the student-directed teaching and faculty-directed teaching groups. The magnitude of the effect (instructor-directed training suture) was considered large (>0.80) in all measurements. The acquisition of suture skills after student-directed training was similar to the training supervised by faculty surgeon, and the increase in suture performances of trainees that received instructor administered training was superior to self-directed learning. © 2013 Springer-Verlag Italia.