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de Carvalho Filho MA, Hafferty FW. Adopting a pedagogy of connection for medical education. MEDICAL EDUCATION 2024. [PMID: 39089707 DOI: 10.1111/medu.15486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 08/04/2024]
Abstract
In this article, we propose developing a "pedagogy of connection" based on the history and evolution of medical education in Brazil. This pedagogy emerged from the intersection of the healthcare and higher educational systems, both dedicated to the principles of social justice and universal access, in response to the country's efforts to address the enduring impacts of slavery and social inequality. Following the "Sanitary Reformation" movement-a foundational moment for Brazil's healthcare and medical education systems-Brazil established the Unified Public Healthcare System (Sistema Único de Saúde - SUS). SUS is founded on principles of universality, integrality, equity, community participation, political and administrative decentralisation, hierarchisation and regionalisation. Aligned with these core principles and inspired by critical pedagogy, Brazilian medical education has evolved with a profound commitment to social justice, critical consciousness, professional presence and compassion. This evolution has given rise to a "pedagogy of connection," which imbues medical education with a sense of purpose and joy, preparing future medical professionals to address the challenges of our ever-evolving society and healthcare systems. The connections fostered by this pedagogy occur in complementary dimensions: (a) healthcare system and society, (b) community, (c) profession, (d) patients, and (e) ourselves. This innovative pedagogy enhances medical education discourse and practice by emphasising the development of a professional identity grounded in social justice and patient-centred care, which remain challenges for current medical education systems. As the global medical education community embraces decolonisation, this pedagogy offers a framework that can be adapted and enriched in various contexts worldwide, fostering opportunities for mutual learning from diverse educational systems in a dialogical and democratic manner.
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Affiliation(s)
- Marco Antonio de Carvalho Filho
- Wenckebach Institute for Education and Training (WIOO), LEARN - Lifelong Education and Assessment Research Network, University Medical Centre Groningen, University of Groningen, Netherlands
| | - Frederic William Hafferty
- Center for Ethics, Professionalism, and the Future of Medicine, American College of Graduate Medical Education, Chicago, Illinois, USA
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Silva JBD, Wright AK, Carvalho AVE, Griffiths CEM, Ashcroft DM. Experience of living with psoriasis in Brazil: a Global Psoriasis Atlas online survey. Int J Dermatol 2024. [PMID: 39021244 DOI: 10.1111/ijd.17387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Psoriasis significantly burdens patients' lives, but there is limited data on this in Brazil. METHODS Between May 2022 and January 2023, we conducted a cross-sectional online survey of 563 Brazilian residents aged ≥18 years who had been diagnosed with psoriasis. Spearman's correlation (r) was used to test the correlation between self-assessed disease severity (Simplified Psoriasis Index [saSPI] extent score; range 0 [clear/minor] to 40 [widespread/severe]) and health-related quality of life (QoL, score of 1 means perfect health) and capability (ICECAP-A: score of 1 means full capability) measures. Multivariable linear regression was used to identify predictors of QoL and capability. A thematic analysis examined the free-text responses and identified common themes. RESULTS The mean age of participants was 42.1 ± 12.4 years, and over half had at least one other long-term condition. The mean QoL score was 0.59 ± 0.25, and the mean capability score was 0.71 ± 0.21. At the time of survey completion, over 80% of respondents reported some level of pain and/or discomfort, and 86% reported feeling anxious and/or depressed. The mean self-assessed saSPI was 7.8 ± 8.6, which negatively correlated with health-related QoL (r = -0.49, P < 0.05) and capability (r = -0.44, P < 0.05). Significant predictors of poorer QoL and reduced capability included high saSPI, number of psoriasis flares and comorbidities, female gender, Black ethnicity, and employment status (unemployed, long-term sick). Frequently reported areas that impacted patients were social stigma/prejudice, powerlessness, lack of education and public awareness, and difficulty obtaining appropriate care/treatment. CONCLUSIONS We found that the clinical manifestations, severity, and associated comorbidities of psoriasis negatively impacted health-related QoL and capability, along with feelings of stigmatization and barriers to specialist treatment. This highlights the need for better access to care and awareness of the disease to improve the lives of people living with psoriasis in Brazil.
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Affiliation(s)
| | - Alison K Wright
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | - André V E Carvalho
- Psoriasis Outpatient Clinic, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Christopher E M Griffiths
- Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Dermatology, King's College Hospital, King's College London, London, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
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Melro LMG, Trindade EM, Park M. COVID-19 underpinning the inverse equity hypothesis between public and private health care in Brazil. CRITICAL CARE SCIENCE 2024; 36:e20240294en. [PMID: 38597485 PMCID: PMC11098063 DOI: 10.62675/2965-2774.20240294-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 04/11/2024]
Affiliation(s)
- Livia Maria Garcia Melro
- Hospital Samaritano PaulistaIntensive Care UnitSão PauloSPBrazilIntensive Care Unit, Hospital Samaritano Paulista - São Paulo (SP), Brazil.
| | - Evelinda Marramon Trindade
- Universidade de São PauloHospital das ClínicasFaculdade de MedicinaSão PauloSPBrazilHealth Technology Assessment Center, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Marcelo Park
- Universidade de São PauloHospital das ClínicasFaculdade de MedicinaSão PauloSPBrazilIntensive Care Unit, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
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Barros GDS, Leal CVF, Leite LAC, Fujimoto DE, Cançado RD. Real-world evidence of the burden of sickle cell disease: a 5-year longitudinal study at a Brazilian reference center. Hematol Transfus Cell Ther 2024; 46:161-166. [PMID: 38307824 DOI: 10.1016/j.htct.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/15/2023] [Accepted: 10/14/2023] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is an inherited and multisystem blood disorder characterized by hemolytic anemia, vaso-occlusive crises (VOCs), progressive multiorgan damage and increased mortality. In Brazil, it is one of the most common monogenic diseases afflicting 60,000 to 100,000 individuals, however, there are sparse epidemiological data, as well as information on the utilization of public healthcare resources. METHOD This was a 5-year (2016 - 2020) retrospective study conducted at one Brazilian reference center on SCD - Santa Casa de Sao Paulo, in Sao Paulo, Brazil. RESULTS Among a total of 100 eligible adult patients, the median age was 31.0 years old, 84% of the patients were aged between 18 and 45 years old; 59% were women and 91% presented the genotype HbSS. The number of hematologist and non-hematologist visits at the outpatient unit were 2,198 and 1,436, respectively. The number of hospital ER visits was 758, of which 51% required 864 days of hospitalization. The main cause for seeking hospital medical care was the VOCs. The numbers and ratios of VOCs were: 1 to 10 VOCs, 64%; 11 to 20, 15%, and; 21 or more, 1%. There was a statistically significant difference between the number of VOCs and hospitalizations, as well as infection. CONCLUSION Results indicate the burden of SCD on Brazilian patients' daily lives, the impact of VOCs on public healthcare resources, the importance of having a national surveillance program to improve resource utilization and clinical outcomes of patients with SCD and the urgent need for the revitalizing of the current national comprehensive SCD care programs.
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Affiliation(s)
| | | | | | - Denys Eiti Fujimoto
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
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Patiño-Lugo DF, Vélez CM, Díaz-Hernández DP, Salazar-Blanco OF, González-Arango JE, Velásquez-Correa JC, Rodríguez-Corredor LC, Vélez-Marín VM, Velásquez-Salazar P. Whoever wants better healthcare simply pays more: citizens' perception about voluntary private health insurance in Colombia. Int J Equity Health 2024; 23:7. [PMID: 38216933 PMCID: PMC10785507 DOI: 10.1186/s12939-023-02086-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES To explore the perceptions that Colombians have about voluntary private health insurance plans (VPHI) in the health system to identify the tensions that exist between the public and private systems. METHODS A qualitative case study approach with 46 semi structured interviews of patients, healthcare workers, healthcare administrators, decision-makers, and citizens. Interviews were recorded, transcribed, anonymized, digitally stored, and analyzed following grounded theory guidelines. RESULTS We developed a paradigmatic matrix that explores how, in a context mediated by both the commodification of health and social stratification, perceptions about the failures in the public health system related to lack of timely care, extensive administrative procedures, and the search for privileged care led to positioning VPHI as a solution to these failures. The interviewees identified three consequences of using VPHI: first, the worsening of problems of timely access to care in the public system; second, higher costs for citizens translated into double payment for technologies and services to which they are entitled; third, the widening of inequity gaps in access to health services between people with similar needs but different payment capacities. CONCLUSIONS These findings can help decision makers to understand citizens´ perceptions about the implications that VPHI may have in worsening equity gaps in the Colombian health system. It also shows, how VPHI is perceived as a double payment for services covered within social security plans and suggests that the perceived lack of timely access to care in the public systems and the fear that citizens have for themselves or their family members when using suboptimal healthcare are important drivers to purchase these private insurances.
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Affiliation(s)
- Daniel Felipe Patiño-Lugo
- Unit of Evidence and Deliberation for Decision Making - UNED, Faculty of Medicine, University of Antioquia, Carrera 51D #62-42, Medellín, Antioquia, Colombia.
- Faculty of Medicine, University of Antioquia, Cra. 51D #62-29, Medellín, Antioquia, Colombia.
- Health Rehabilitation Research Group, Faculty of Medicine, University of Antioquia, Medellín, Colombia.
| | - Claudia Marcela Vélez
- Faculty of Medicine, University of Antioquia, Cra. 51D #62-29, Medellín, Antioquia, Colombia
- Health Rehabilitation Research Group, Faculty of Medicine, University of Antioquia, Medellín, Colombia
| | - Diana Patricia Díaz-Hernández
- Faculty of Medicine, University of Antioquia, Cra. 51D #62-29, Medellín, Antioquia, Colombia
- EDUSALUD Research Group, Faculty of Medicine, University of Antioquia, Medellín, Antioquia, Colombia
| | - Olga Francisca Salazar-Blanco
- Faculty of Medicine, University of Antioquia, Cra. 51D #62-29, Medellín, Antioquia, Colombia
- EDUSALUD Research Group, Faculty of Medicine, University of Antioquia, Medellín, Antioquia, Colombia
| | - Juan Esteban González-Arango
- Unit of Evidence and Deliberation for Decision Making - UNED, Faculty of Medicine, University of Antioquia, Carrera 51D #62-42, Medellín, Antioquia, Colombia
| | - Juan Carlos Velásquez-Correa
- Unit of Evidence and Deliberation for Decision Making - UNED, Faculty of Medicine, University of Antioquia, Carrera 51D #62-42, Medellín, Antioquia, Colombia
- Health Rehabilitation Research Group, Faculty of Medicine, University of Antioquia, Medellín, Colombia
| | - Leydi Camila Rodríguez-Corredor
- Unit of Evidence and Deliberation for Decision Making - UNED, Faculty of Medicine, University of Antioquia, Carrera 51D #62-42, Medellín, Antioquia, Colombia
- Epidemiology Group, National Faculty of Public Health, University of Antioquia, Medellín, Antioquia, Colombia
| | - Viviana María Vélez-Marín
- Unit of Evidence and Deliberation for Decision Making - UNED, Faculty of Medicine, University of Antioquia, Carrera 51D #62-42, Medellín, Antioquia, Colombia
| | - Pamela Velásquez-Salazar
- Unit of Evidence and Deliberation for Decision Making - UNED, Faculty of Medicine, University of Antioquia, Carrera 51D #62-42, Medellín, Antioquia, Colombia
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Aissaoui N, Hamaizia L, Brika SK, Shama TRAE. What will the ambitions of primary healthcare be in the 21 st century? Pan Afr Med J 2022; 43:87. [PMID: 36605980 PMCID: PMC9805306 DOI: 10.11604/pamj.2022.43.87.35235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/07/2022] [Indexed: 11/05/2022] Open
Abstract
This article attempts to analyze the problem of the modernity of primary healthcare, as well as the reforms to be implemented in a new context characterized by COVID-19. This article offers another vision to follow, to build a modern primary healthcare system. It is a descriptive and analytical study, which addresses the failure of the health system in general, as it proposes the reforms necessary to provide equitable, efficient and modern primary healthcare. The results clearly show that we can no longer act unilaterally; multi-sector efforts at the national level should be encouraged: we must act, in a preventive way, on the causes of the disease; international agreements on the environment, prices of basic foods and medicines, etc. are much needed to improve the health status of middle and low income countries, the case of the majority of African countries. So, different solutions can be conveyed by primary healthcare, in order to improve the whole health system.
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Affiliation(s)
- Nasreddine Aissaoui
- Department of Finance Sciences, Faculty of Economics, Business and Management Sciences, Oum El Bouaghi University, Oum El Bouaghi, Algeria
| | - Lamia Hamaizia
- Department of Management Sciences, Faculty of Economics, Business and Management Sciences, Oum El Bouaghi University, Oum El Bouaghi, Algeria
| | - Said Khalfa Brika
- Departement of Administrative Sciences, Applied College, University of Bisha, Bisha, Saudi Arabia
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Fernandes AG, Ferraz AN, Brant R, Malerbi FK. Diabetic retinopathy screening and treatment through the Brazilian National Health Insurance. Sci Rep 2022; 12:13941. [PMID: 35977971 PMCID: PMC9385734 DOI: 10.1038/s41598-022-18054-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 08/04/2022] [Indexed: 11/09/2022] Open
Abstract
The current study aimed to investigate diabetic retinopathy (DR) screening and treatment coverages among diabetic patients evaluated through the Brazilian National Health Insurance from 2014 to 2019. The Brazilian Public Health System Information Database was used as the primary data source. DR screening coverage was calculated as the rate of procedures of clinical dilated fundus exam and color fundus photograph over the number of diabetic patients. DR treatment coverage was calculated as the rate of procedures of intravitreal injection, photocoagulation, and panretinal photocoagulation over the number of diabetic patients presumably in need of DR treatment. The overall screening coverage increased from 12.1% in 2014 to 21.2% in 2019 (p < 0.001) with substantial regional discrepancies so that North region was the only one with no changes along the period. The overall treatment coverage increased from 27.7% in 2014 to 44.1% in 2019, with Southeast and Midwest absorbing the demand for service from the North, Northeast and South. Despite an improvement along the past years, both screening and treatment coverages for DR in diabetes patients are ineffective in Brazil. Public health policies should address resources disparities throughout the country aiming to offer same healthcare conditions to patients regardless their geographic location.
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Affiliation(s)
- Arthur Gustavo Fernandes
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of Sao Paulo, Rua Botucatu, 816, São Paulo, SP, 04023-062, Brazil. .,Department of Anthropology and Archaeology, University of Calgary, Calgary, AB, Canada.
| | - Aline Nunes Ferraz
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of Sao Paulo, Rua Botucatu, 816, São Paulo, SP, 04023-062, Brazil
| | - Rodrigo Brant
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of Sao Paulo, Rua Botucatu, 816, São Paulo, SP, 04023-062, Brazil
| | - Fernando Korn Malerbi
- Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of Sao Paulo, Rua Botucatu, 816, São Paulo, SP, 04023-062, Brazil
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