Perceptions of psychological content in the GP consultation - the role of practice, personal and prescribing attributes

Objective: The aim of the present study was to determine the relationship between the characteristics of general practices and the perceptions of the psychological content of consultations by GPs in those practices. Methods: A cross-sectional survey was conducted of all GPs (22 GPs based in nine practices) serving a discrete inner city community of 41 000 residents. GPs were asked to complete a log-diary over a period of five working days, rating their perception of the psychological content of each consultation on a 4-point Likert scale, ranging from 0 (no psychological content) to 3 (entirely psychological in content). The influence of GP and practice characteristics on psychological content scores was examined. Results: Data were available for every surgery-based consultation (n = 2206) conducted by all 22 participating GPs over the study period. The mean psychological content score was 0.58 (SD 0.33). Sixty-four percent of consultations were recorded as being without any psychological content; 6% were entirely psychological in content. Higher psychological content scores were significantly associated with younger GPs, training practices (n = 3), group practices (n = 4), the presence of on-site mental health workers (n = 5), higher antidepressant prescribing volumes and the achievement of vaccine and smear targets. Training status had the greatest predictive power, explaining 51% of the variation in psychological content. Neither practice consultation rates, GP list size, annual psychiatric referral rates nor volumes of benzodiazepine prescribing were related to psychological content scores. Conclusion: Increased awareness by GPs of the psychological dimension within a consultation may be a feature of the educational environment of training practices.

Avaliação do impacto do treinamento de clínica em hanseníase e sua contribuição para o aumento da detecção da doença no Estado do Rio Grande do Norte

Hansen´s disease is considered a serious public health problem. In 2006, the Ministry of Health reported that worldwide, Brazil ranked 2nd in the number of cases of the disease, surpassed only by India. The North region is the geographical area in Brazil that presents the most cases. In the state of Rio Grande do Norte, the disease is considered to be eliminated because its prevalence has been identified as 1 per 10.000 inhabitants, criteria established by the State Elimination Letter of 2005. Training programs have been offered by the Coordination for the Control of Hansen´s Disease Program of Rio Grande do Norte, PCH-RN since 1997, with the support of the English governmental agency Leprosy Relief Association, LRA, with no evaluation having been conducted. The objective of this study was to evaluate the training programs in clinical diagnosis of Hansen´s disease and their contribution to the detection of the disease in the state of Rio Grande do Norte. The study was conducted in seven municipalities that are known as Regional Public Health Units (URSAPs): São José de Mipibu URSAP I, Mossoró URSAP II, João Câmara URSAP III, Caicó URSAP IV, Santa Cruz URSAP V, Pau dos Ferros URSAP VI and Natal, capital city of the State, in the Metropolitan Region. Physicians and nurses of the Family Health Program PSF were interviewed as to their perceptions of the implementation of the training program in clinica diagnosis of Hansen´s Disease conducted by the PCH-RN. They evaluated their own practice and the training program. These professionals presented a positive evaluation of the program and gave suggestions for future courses. The results of this study suggest the need for permanent education. Data of the disease obtained from the official records of the Secretariat of Health and from the interviews indicate that health education is the means to control Hansen´s disease effectively

Famílias privadas de liberdade: a saga da violência vivenciada por adolescentes que trilham os áridos caminhos da criminalidade

This paper has as its main focus the relation between the infringement act and the adolescents families social economical problematic, who obey the social educational deprivation of freedom at CEDUC in the district of Pitimbu RN, establishing in the theme Children and Adolescents, with the objective of showing how these families breed in the social economical and cultural political aspect. It also seizes who those adolescents are and their family members in their social aspect and as those families face their daily activities. The focus on the social matter, family, adolescent, infringement act, exclusion, inclusion formed the analysis categories which made myths and reality possible, taking into consideration the infringement act in our society. The data collection showed that those families conditions of life are of poverty. Families originated from low social classes, 62.5 % coming from the countryside and living with a daily income ranging from R$ 0,31 to R$ 8,31. Their level of education is low; there is lack of human and citizenship rights and no professional qualification whatsoever. It questions the degrading social exclusion suffered by millions of Brazilian people due to social, political and infringement economical problems. Has this favored the infringement practice? How to confirm the families lack of competence having the social vulnerability? Are the Public Political Institutions really performing the way they should? Are they really carrying out their role as they should? We have noticed that from then on, the necessity of understanding the exclusion/inclusion suffered not only in an imprecise and empty way, but understood as processes of integrative exclusion or ways of delinquency, where the excluding is not only the only one who has lack of material care but the one who is seen or recognized as a person, is not being treated as one. The effort of this paper provided an approach to our object, and the seizing of a close relation between the infringement act and the exclusion process or inclusion suffered, which are submitted to families of those adolescents who deprive of freedom

Educação em saúde como estratégia de promoção de saúde bucal em gestantes

O objetivo desta revisão da literatura é discutir a importância da educação em saúde como estratégia de promoção de saúde bucal no período gestacional. Foram estudadas as manifestações bucais mais comuns na gestação, concluindo-se que, embora a gestação por si só não seja responsável por tais manifestações como, por exemplo, a cárie dentária e a doença periodontal, faz-se necessário o acompanhamento odontológico no pré-natal, considerando-se que as alterações hormonais da gravidez poderão agravar as afecções já instaladas. Destacou-se na promoção de saúde bucal na gestante a educação em saúde bucal, considerando-a parte importante do Programa de Atenção à Saúde da Mulher, conforme recomendado pelas atuais Diretrizes da Política Nacional de Saúde Bucal. Considera-se que, por meio de ações de educação em saúde bucal, desenvolvidas no pré-natal por uma equipe multiprofissional, orientada por um cirurgião-dentista, a mulher poderá se conscientizar da importância de seu papel na aquisição e manutenção de hábitos positivos de saúde bucal no meio familiar e atuar como agente multiplicador de informações preventivas e de promoção de saúde bucal.

Modo de vida na várzea: políticas sociais e nova ruralidade: estudo em uma localidade da Reserva de Desenvolvimento Sustentável Mamirauá

Esta dissertação é um estudo sobre as ações em torno do desenvolvimento sustentável e de políticas não agrícolas para as pequenas populações rurais, a partir dos anos 80 e 90. Com a interiorização das políticas, o Estado se torna mais presente nas regiões interioranas redimensionando o mundo rural e suas dinâmicas locais. Neste sentido, um novo rural emerge com as ações políticas que chegam às populações mais distantes expondo o modo de vida a novas situações. Este estudo objetivou analisar as mudanças na organização social e econômica dos moradores da localidade rural de Vila Alencar da Reserva de Desenvolvimento Sustentável Mamirauá (RDSM), no estado do Amazonas, decorrentes da criação de uma reserva de desenvolvimento sustentável (RDS) e das ações institucionalizadas por políticas de Estado. A análise teórica foi fundamentada na noção de habitus e do campo socioambiental da Reserva Mamirauá. Realizaram-se também análises entre as famílias a partir do tempo de união conjugal, com a finalidade de identificar as mudanças ocorridas entre duas gerações familiares. Constatou-se neste estudo que a organização familiar em Vila Alencar se desenvolve levando em consideração as práticas locais e também participam das ações intervencionistas através das políticas sociais por meio do Programa Bolsa Família, das aposentadorias rurais e das atividades em torno do manejo sustentável dos recursos naturais, que estão em sua maioria associadas ao manejo de ecoturismo, a exemplo, da prestação de serviços como guia turístico, auxiliar de cozinha, copeira e carpintaria para a pousada de ecoturismo da RDSM. A combinação de atividades agrícolas, nãoagrícolas e a complementação de renda por benefícios sociais assumem papel importante na composição da renda familiar, o que traz novas perspectivas à reprodução social. O estudo mostrou que as políticas de desenvolvimento sustentável bem como as políticas de benefícios sociais tornam favorável à organização familiar das localidades rurais as características de feições modernizadoras e atrativas do conforto urbano, sobretudo pela expectativa da compra de uma casa na cidade e de melhores condições de qualificação aos filhos para prosperarem em alguma profissão. Aos jovens são delegadas outras responsabilidades que não se inserem exclusivamente no contexto produtivo do trabalho familiar.

Terminologia da atenção primária à saúde

INTRODUÇÃO: Muitos termos da área de Atenção Primária à Saúde não são utilizados adequadamente. É importante resgatar a origem desses termos, a fim de entender porque são usados de maneiras diferentes por trabalhadores da saúde e pela população leiga. OBJETIVO: Pesquisar e discutir os significados e usos de termos ligados àAtenção Primária à Saúde. MÉTODO: Revisão, em diferentes fontes, de significados de termos como Atenção Primária à Saúde, medicina de família, clínica geral, medicina interna, Programa Saúde da Família. RESULTADOS: Referências diferentes geralmente têm o mesmo significado para termos similares. Alguns termos, como, por exemplo, "clínica médica", que na prática significa "medicina interna", não têmorigem clara. DISCUSSÃO: Muitos termos são usados indevidamente por causa de diferentes interesses e motivos históricos. Este trabalho não pretende esgotar a discussão sobre a importância da terminologia na Atenção Primária. É um campo relevante de investigação, porque pode ajudar a comunicação entre pacientes, profissionais da saúde e políticos e, em especial, colaborar para o adequado entendimento pelos estudantes deste cenário de prática.

Outcome and patients' satisfaction after functional treatment of acute lateral ankle injuries at emergency departments versus family doctor offices

BACKGROUND: In some Western countries, more and more patients seek initial treatment even for minor injuries at emergency units of hospitals. The initial evaluation and treatment as well as aftercare of these patients require large amounts of personnel and logistical resources, which are limited and costly, especially if compared to treatment by a general practitioner. In this study, we investigated whether outsourcing from our level 1 trauma center to a general practitioner has an influence on patient satisfaction and compliance. METHODS: This prospective, randomized study, included n = 100 patients who suffered from a lateral ankle ligament injury grade I-II (16, 17). After radiological exclusion of osseous lesions, the patients received early functional treatment and were shown physical therapy exercises to be done at home, without immobilization or the use of stabilizing ortheses. The patients were randomly assigned into two groups of 50 patients each: Group A (ER): Follow-up and final examination in the hospital's emergency unit. Group B (GP): Follow-up by general practitioner, final examination at hospital's emergency unit. The patients were surveyed regarding their satisfaction with the treatment and outcome of the treatment. RESULTS: Female and male patients were equally represented in both groups. The age of the patients ranged from 16 - 64 years, with a mean age of 34 years (ER) and 35 years (GP). 98% (n = 98) of all patients were satisfied with their treatment, and 93% (n = 93) were satisfied with the outcome. For these parameters no significant difference between the two groups could be noted (p = 0.7406 and 0.7631 respectively). 39% of all patients acquired stabilizing ortheses like ankle braces (Aircast, Malleoloc etc.) on their own initiative. There was a not significant tendency for more self-acquired ortheses in the group treated by general practicioners (p = 0,2669). CONCLUSION: Patients who first present at the ER with a lateral ankle ligament injury grade I-II can be referred to a general practitioner for follow-up treatment without affecting patient satisfaction regarding treatment and treatment outcome.

Practitioners' Views of Family Strengths: A Delphi Study

Reported is a research study to assess the opinions of family practitioners on the status of families in Oklahoma. Researchers employed the Delphi method to achieve consensus among key informants in the family practice field about the strengths and weaknesses of Oklahoma families, threats facing families in the state, and means to strengthening family life in Oklahoma. The study yielded qualitative data from the key informants, which the researchers then condensed into response categories to feed back to informants to rate. Family practitioners identified resilience, spirituality, and access to support systems as the greatest strengths, and listed substance abuse, poverty, and generational cycles of dysfunction as the greatest weaknesses of Oklahoma families. Recommendations by these practitioners are given for improvements in addressing family needs.

Patient information leaflets: informing or frightening? A focus group study exploring patients' emotional reactions and subsequent behavior towards package leaflets of commonly prescribed medications in family practices.

BACKGROUND The purpose of patient information leaflets (PILs) is to inform patients about the administration, precautions and potential side effects of their prescribed medication. Despite European Commission guidelines aiming at increasing readability and comprehension of PILs little is known about the potential risk information has on patients. This article explores patients' reactions and subsequent behavior towards risk information conveyed in PILs of commonly prescribed drugs by general practitioners (GPs) for the treatment of Type 2 diabetes, hypertension or hypercholesterolemia; the most frequent cause for consultations in family practices in Germany. METHODS We conducted six focus groups comprising 35 patients which were recruited in GP practices. Transcripts were read and coded for themes; categories were created by abstracting data and further refined into a coding framework. RESULTS Three interrelated categories are presented: (i) The vast amount of side effects and drug interactions commonly described in PILs provoke various emotional reactions in patients which (ii) lead to specific patient behavior of which (iii) consulting the GP for assistance is among the most common. Findings show that current description of potential risk information caused feelings of fear and anxiety in the reader resulting in undesirable behavioral reactions. CONCLUSIONS Future PILs need to convey potential risk information in a language that is less frightening while retaining the information content required to make informed decisions about the prescribed medication. Thus, during the production process greater emphasis needs to be placed on testing the degree of emotional arousal provoked in patients when reading risk information to allow them to undertake a benefit-risk-assessment of their medication that is based on rational rather than emotional (fearful) reactions.

The Church Music Program: The Effect of Moving from Performance-based to Education-based Emphasis in a Church Music Program

This research project sought to answer the primary research question: What occurs when the music program in a church changes its emphasis from performance to education? This qualitative study of a church choir included participant observation of Wednesday evening and Sunday morning rehearsals over a 12 week period, individual interviews, group interviews, written responses, and written and visual assessment of musical skills. The goal was a rich description of the participants and emerging themes resulting from the shift in emphasis. Analysis of data occurred through inductive processing. Data was initially coded and then the codes were categorized into sub-themes, and finally into major themes. Early analysis of the data began with reflection in a researcher journal. Following the completion of the study the journal was entered into a word processor, as were transcriptions of videotaped rehearsals, and written reflections from the participants. After all data had been reviewed repeatedly and entered into the word processor, it was coded, reexamined, and finally categorized into sub-themes and themes. After coding and identification of major themes and sub-themes the finding were challenged by looking for disconfirming evidence. Finally, after the completion of the analysis stage, member checks were conducted. The results of the analysis of data revealed themes that could be associated either with the choir or the director. The key themes primarily associated with the choir were: Response to the change in rehearsal format; Attitude toward learning; Appropriateness of community learning model; and, Member's perceptions of the results of the program. The key themes associated with the director were identified as: Conductor assuming the role of educator; Conductor recognizing the choir as learners; Conductor treating rehearsals as a time for teaching and learning; and, Conductor's perception of the effectiveness of the change in focus. The study concluded that a change in focus from performance to education did not noticeably improve the sound of the choir after twelve-weeks. There were however, indications that improvements were being made by the individual members. Further study of the effects over a longer period of time is recommended.

A review of the published literature on interventions to increase compliance with follow-up outpatient medical appointments in primary care practice

Effective strategies for patient follow-up compliance in family practice are essential for the prevention and early detection of disease with the consequences of decreasing morbidity and mortality. With effective appointment reminder systems in place, physicians can better manage the overall health of their patients by providing preventive care as well. This literature review examines intervention strategies used by the authors, the compliance rate of appointment adherence using these techniques, as well as theories relating to study outcomes. The findings of this study may be used as an educational tool by practices to suggest which intervention strategies might be the most effective for their clinic.^

Evaluation of Knowledge Regarding Diagnostic Strategies for Genetic Diseases in Select Residents

Genetics education for physicians has been a popular publication topic in the United States and in Europe for over 20 years. Decreasing numbers of medical genetics professionals and an increasing volume of genetic information has created a dire need for increased genetics training in medical school and in clinical practice. This study aimed to assess how well pediatrics-focused primary care physicians apply their general genetics knowledge to clinical genetic testing using scenario-based questions. We chose to specifically focus on knowledge of the diagnostic applicability of Chromosomal Microarray (CMA) technology in pediatrics because of its recent recommendation by the International Standard Cytogenomic Array (ISCA) Consortium as a first-tier genetic test for individuals with developmental disabilities and/or congenital anomalies. Proficiency in ordering baseline genetic testing was evaluated for eighty-one respondents from four pediatrics-focused residencies (categorical pediatrics, pediatric neurology, internal medicine/pediatrics, and family practice) at two large residency programs in Houston, Texas. Similar to other studies, we found an overall deficit of genetic testing knowledge, especially among family practice residents. Interestingly, residents who elected to complete a genetics rotation in medical school scored significantly better than expected, as well as better than residents who did not elect to complete a genetics rotation. We suspect that the insufficient knowledge among physicians regarding a baseline genetics work-up is leading to redundant (i.e. concurrent karyotype and CMA) and incorrect (i.e. ordering CMA to detect achondroplasia) genetic testing and is contributing to rising health care costs in the United States. Our results provide specific teaching points upon which medical schools can focus education about clinical genetic testing and suggest that increased collaboration between primary care physicians and genetics professionals could benefit patient health care overall.

Incidencia de un Programa de Alfabetización Familiar : Evaluación de actitudes y conocimientos sobre el mundo letrado en niños de sectores populares

El propósito de esta investigación cualitativa es indagar, a través de un estudio descriptivo- interpretativo, la eventual incidencia de un Programa de Alfabetización Familiar en la inclusión de los niños en la cultura escrita al ingresar al primer año escolar. Para esto se evaluarán ciertas actitudes vinculadas con el tipo de contacto que establecen los hijos de algunos participantes con la cultura de los libros y los conocimientos construidos acerca del sistema de escritura y del lenguaje escrito, como así también el desarrollo de estrategias lectoras. Se parte del análisis del Programa de Alfabetización con la Familia 'Cuenta Quien Cuenta', iniciado en el año 2006 en Paysandú, Uruguay, destinado a padres, madres y otros referentes familiares de niños hasta 5 años de edad, pertenecientes a contextos de alta vulnerabilidad económica, social y cultural. El programa tiene una duración de cuatro meses, en los se desarrollan doce talleres. En estos espacios se leen cuentos, se comparten pistas sobre cómo promover la lectura frecuente y la conversación sobre libros y cuentos en el hogar, se compaginan libros y, sobre todo, se insiste en la revalorización del rol de los asistentes como primeros agentes alfabetizadores de sus hijos. Al finalizar el período de intervención, cada hogar cuenta con alrededor de dieciséis libros de cuentos como material de lectura. El relevamiento realizado sobre otros programas y experiencias de este tipo puso de manifiesto que, en general, están centrados en la descripción del seguimiento realizado y en la socialización de registros anecdóticos, no incluyendo publicaciones que den cuenta de la evaluación de sus efectos en cuanto a los conocimientos de los niños. Por esa razón, esta investigación procura aportar un conjunto de herramientas que permitan iniciar un camino tendiente a focalizar indicadores que permitan evaluar más específicamente los alcances de las acciones realizadas

Incidencia de un Programa de Alfabetización Familiar : Evaluación de actitudes y conocimientos sobre el mundo letrado en niños de sectores populares

El propósito de esta investigación cualitativa es indagar, a través de un estudio descriptivo- interpretativo, la eventual incidencia de un Programa de Alfabetización Familiar en la inclusión de los niños en la cultura escrita al ingresar al primer año escolar. Para esto se evaluarán ciertas actitudes vinculadas con el tipo de contacto que establecen los hijos de algunos participantes con la cultura de los libros y los conocimientos construidos acerca del sistema de escritura y del lenguaje escrito, como así también el desarrollo de estrategias lectoras. Se parte del análisis del Programa de Alfabetización con la Familia 'Cuenta Quien Cuenta', iniciado en el año 2006 en Paysandú, Uruguay, destinado a padres, madres y otros referentes familiares de niños hasta 5 años de edad, pertenecientes a contextos de alta vulnerabilidad económica, social y cultural. El programa tiene una duración de cuatro meses, en los se desarrollan doce talleres. En estos espacios se leen cuentos, se comparten pistas sobre cómo promover la lectura frecuente y la conversación sobre libros y cuentos en el hogar, se compaginan libros y, sobre todo, se insiste en la revalorización del rol de los asistentes como primeros agentes alfabetizadores de sus hijos. Al finalizar el período de intervención, cada hogar cuenta con alrededor de dieciséis libros de cuentos como material de lectura. El relevamiento realizado sobre otros programas y experiencias de este tipo puso de manifiesto que, en general, están centrados en la descripción del seguimiento realizado y en la socialización de registros anecdóticos, no incluyendo publicaciones que den cuenta de la evaluación de sus efectos en cuanto a los conocimientos de los niños. Por esa razón, esta investigación procura aportar un conjunto de herramientas que permitan iniciar un camino tendiente a focalizar indicadores que permitan evaluar más específicamente los alcances de las acciones realizadas