Applying the Generalizability Theory to Identify the Sources of Validity Evidence for the Quality of Communication Questionnaire

Effective doctor-patient-family communication is an integral and sensitive part of health care, assessing its quality is essential to identify aspects needing disclosure and, if necessary, improvement. Cross-sectional study aimed to analyze the sources of evidence of validity and the number of participants needed to reliably apply the Quality of Communication Questionnaire (QoC) through Generalizability Theory (GT). The mean age of the 150 patients hospitalized at the end of life was 50.5 (SD = 13.8) years, the mean hospital length of stay was 7.5 (SD = 10.2) days, 56.9% were male. Regarding the 105 patients' family members of patients whose mean length of hospital stay was 9.5 (SD = 9.1) days, their mean age was 42.2 (SD = 14.7) years, 69.5% were female. GT was used to quantify the minimum number of questionnaires needed, with the aim of reaching a reliable estimate of QoC with G-coefficients. To reach a reliability of .90, there is a need for 25 for the Eρ2 questionnaires and 35 for the Φ. The exact estimation identified the minimum number of questionnaires required for the evaluation of physicians by patients. To obtain a reliability of .90, there is a need for 30 and 40 questionnaires for the G-coefficients. A practical and fast application makes it possible to use QoC in its entirety or alone to evaluate general communication or communication about palliative care. Furthermore, based on these results, it was possible to identify which aspects were effective or ineffective in these contexts.

[In the final analysis, who is "problematic"? An integrative review of patients, physicians and problematic relationships]

The scope of this study was to assess the literature on the characteristics of patients, physicians, and physician-patient relationships considered 'problematic.' An integrative review of primary studies published between January 1, 2016, and September 30, 2021, in Portuguese, English and Spanish was conducted, Of the 3,414 papers identified in the PubMed, Embase, Scopus and Lilacs databases, 19 were selected for qualitative analysis. Seven studies were carried out in Europe, eight in North America, two in South America and two in China, totaling 1,694 patients, 1,903 assistant physicians, 101 residents and 160 medical academics. Physicians and academics considered the following to be problematic: patients with clinical conditions such as psychosomatic and chronic illnesses; symptoms and complaints such as pain; powerful emotions; problems in obtaining and sharing information, in decision-making, in the adherence to the therapeutic plan and in their self-care; and some sociodemographic and vulnerability characteristics. Among other aspects, patients, or their relatives, considered physicians to be problematic when they did not listen to them or appear to care about their children, Teaching medical communication and systemic interventions are recommended to improve physician-patient relationships.

Adaptation of the Quality of Communication Questionnaire for Family Members and Its Validity Evidence for Use in Brazil

Assessment of communication between physicians and patients' family members is essential to improving healthcare quality. To adapt the Quality of Communication Questionnaire (QoC) for family members and to analyze its validity evidence for use in Brazil. Data were collected between 2017 and 2019, with family members of patients in intensive care (IC) and palliative care (PC) from five public hospitals in the South Brazil. The QoC was adapted for family members for use in Brazil, and its cross-cultural adaptation was carried out. The clarity and cultural appropriateness of the pre-final version were evaluated by 30 family members of patients in IC. The final version was responded by 198 family members of patients. All items were considered clear, and appropriate to Brazilian culture. The goodness of fit index for proposed model had CFI 0.96 (CI95%: 0.94 - 0.98), TLI 0.95 (CI95%: 0.92 - 0.97), RMSEA 0.07 (CI90%: 0.06 - 0.08), and χ²/df 2.18. Cronbach's alpha coefficient (α) among family members of patients in PC was 0.88 for the general communication (first subscale) and 0.80 for the end-of-life communication (second subscale). However, among family members of patients in IC, α was 0.86 for the first subscale and only 0.53 for the second subscale. The QoC for family members and its cross-cultural adaptation were carried out successfully. It has strong validity evidence among those with loved ones in PC, but only the QoC general communication subscale has strong validity evidence among those with loved ones in IC.

Communication in healthcare: experience of students and professionals from teaching- learning to practice in health

Objectives

This study aimed to understand the teaching-learning experience in the Communication in Healthcare class among students, teaching assistants, and health professionals, as well as its applications to professional practice.

Methods

This is a qualitative study with a theoretical approach based on Gadamer's Philosophical Hermeneutics and a methodological framework based on Minayo and Bardin's thematic content analysis. Communication in Healthcare is an elective multiprofessional class, which lasts one semester and is offered regularly. All former students (n = 368) were invited to participate by email, and 30 participated in these focus groups (13 students, 8 teaching assistants, and 9 health professionals). The online focus groups took place on an online platform, and they were video-recorded and subsequently transcribed. Through cross-sectional and vertical analysis, the main themes were identified.

Results

The Communication in Healthcare class was an important step for personal, professional, and interprofessional formation and development of communication competence. The following dominant themes were identified: 1) motivation for signing up, 2) prior expectations, 3) meaning of the experience and shaping moments, 4) how the teaching-learning experience was retained and what was retained, 5) repercussions in relation to self, others, and professional life, and 6) reflections about the curriculum, interprofessional dialogue, and formation.

Conclusions

The teaching-learning experience was important for the formation of communicational competence. This research contributes to medical education and opens teaching-learning paths for communication skills, empathy, dialogue, and interprofessionalism. Future studies with a philosophical hermeneutic framework and online focus groups are indicated for the comprehension of educational interventions in health.

Needs of family members of patients in intensive care and their perception of medical communication

OBJECTIVE

To understand the perception of medical communication and needs of family members with loved ones in intensive care.

METHODS

The study was mainly qualitative and exploratory, with thematic analysis of comments made by 92 family members with loved ones in intensive care units when answering in-person interviews comprising the Quality of Communication Questionnaire (QoC) and open-ended questions about their need for additional help, the appropriateness of the place where they received information, and additional comments.

RESULTS

The participants' mean age was 46.8 years (SD = 11.8), and most of them were female, married and had incomplete or completed elementary education. The following themes were found: perception of characteristics of medical communication; feelings generated by communication; considerations about specific questions in the QoC; family members' needs; and strategies to overcome needs regarding communication. Characteristics that facilitated communication included attention and listening. Characteristics that made communication difficult included aspects of information sharing, such as inaccessible language; lack of clarity, objectivity, sincerity, and agreement among the team; limited time; and inadequate location. Feelings such as shame, helplessness, and sadness were cited when communication was inadequate. Family members' needs related to communication included more details about the loved one's diagnosis, prognosis, and health condition; participation in decisionmaking; and being asked about feelings, spirituality, dying and death. Others were related to longer visitation time, psychological support, social assistance, and better infrastructure.

CONCLUSION

It is necessary to enhance medical communication and improve hospital infrastructure to improve the quality of care for family members.

The COVID-19 pandemic and teachers' work: perceptions of teachers from a public university in the state of São Paulo, Brazil

The COVID-19 pandemic required the restructuring of educational models, including the rapid transition from face-to-face to remote education. The aim of this qualitative research was to understand the effect of the COVID-19 pandemic on undergraduate professors' work and health at a public university in the state of São Paulo. Semi-structured interviews were conducted with 17 undergraduate faculty of humanities, biological and exact sciences form August to September 2020. The interviews were recorded and transcribed. From the content analysis, four thematic categories emerged: (1) changes in the work routine and their impacts, including adjustment to remote work and the difficulties in establishing boundaries between work and their personal life; (2) changes in the dynamics between faculty and students and the possibility of rethinking teaching practice; (3) the relationship between faculty and the university with emphasis on the decision-making process, support for the transition to remote teaching, and concerns about the quality of teaching; and (4) anguish and fears related to the pandemic that added to the set of work-related stressors. Our findings showed that actions towards the communicational dynamics, as well as actions towards faculties' mental health should be implemented.

The COVID-19 pandemic and teachers’ work: perceptions of teachers from a public university in the state of São Paulo, Brazil

Abstract The COVID-19 pandemic required the restructuring of educational models, including the rapid transition from face-to-face to remote education. The aim of this qualitative research was to understand the effect of the COVID-19 pandemic on undergraduate professors’ work and health at a public university in the state of São Paulo. Semi-structured interviews were conducted with 17 undergraduate faculty of humanities, biological and exact sciences form August to September 2020. The interviews were recorded and transcribed. From the content analysis, four thematic categories emerged: (1) changes in the work routine and their impacts, including adjustment to remote work and the difficulties in establishing boundaries between work and their personal life; (2) changes in the dynamics between faculty and students and the possibility of rethinking teaching practice; (3) the relationship between faculty and the university with emphasis on the decision-making process, support for the transition to remote teaching, and concerns about the quality of teaching; and (4) anguish and fears related to the pandemic that added to the set of work-related stressors. Our findings showed that actions towards the communicational dynamics, as well as actions towards faculties’ mental health should be implemented.

Patients' perception of medical communication and their needs during the stay in the intensive care unit

OBJECTIVE

To understand the perception of patients about medical communication as well as their needs during hospitalization in the intensive care unit.

METHODS

This study was cross-sectional descriptive and qualitative exploratory including 103 patients admitted to or recently discharged from the intensive care units of four hospitals in Greater Florianópolis, Santa Catarina state, Brazil. The patients' sociodemographic and clinical variables were studied, as were the score they gave to the quality of medical communication through the Quality of Communication Questionnaire and their spontaneous comments with reflections or justifications for the scores given, and their responses on how they felt and what complementary help they would have liked to receive. The quantitative data were analyzed by descriptive and analytical statistics, and the qualitative data were analyzed by thematic content analysis.

RESULTS

The mean Quality of Communication Questionnaire score was 5.1 (standard deviation - SD = 1.3), with 8.6 (SD = 1.3) on the general communication subscale and 2.1 (SD = 1.8) on the end-of-life communication subscale. The patients had a variable understanding of medical language. Some physicians seemed to be "rushed", according to some patients. Other patients would like to receive more frequent and detailed information and/or be respected and taken "more seriously" when they reported pain. Anxiety, sadness, and fear were among the reported feelings. Other needs included silence, more time for visits, the presence of a companion, psychological and social-work care, a bathroom that they could use, and better food in the intensive care unit.

CONCLUSION

The quality of medical communication with patients is good but could improve if physicians and the healthcare team had more time for patients. Other felt needs included respect, pain relief, and adjustments in the intensive care unit dynamics and environment.

Quality of Communication Questionnaire for Patients Hospitalized in Intensive and Palliative Care: Validity Evidence for Use in Brazil

The Quality of Communication Questionnaire (QoC) was culturally adapted for Brazil due to its importance and use in several studies and different scenarios. The objective of this study was to evaluate the validity evidence of the Brazilian version of the QoC. A validation study was carried out involving 253 patients admitted to five public hospitals in Southern Brazil. Data were analyzed using descriptive analysis, Cronbach's alpha (α) to assess internal consistency, exploratory factor analysis, and goodness-of-fit index. One hundred and three patients were in intensive care (IC), and 150 were in palliative care (PC). The participants' mean age was 51 years (SD = 14.2). QoC,and its general communication subscale, and end-of-life communication subscale means were 5.5 (SD = 1.6), 8.8 (SD = 1.5), and 5.5 (SD = 1.6) respectively. Among patients in IC, QoC Cronbach's alpha was .75, and .84 in the general communication subscale and .51 in the end-of-life communication subscale. Among patients in PC, QoC Cronbach's alpha was .83, and .88 in the general communication subscale, and .71 in the end-of-life communication subscale. The root mean square error of approximation was .07 (90% CI: .04 - .08); Tucker-Lewis index was .97 (95% CI: .95 - .98); comparative fit index was .98 (95% CI: .97 - .99), and χ²/df ratio was 1.33 (χ²[53] = 70.858, p = .05). The authors conclude that the general communication subscale of QoC Brazilian version has good validity evidence for patients in IC and PC, whereas the end-of-life communication subscale is only valid for patient in PC.

Media and scientific communication about the COVID-19 pandemic and the repercussions on the population's mental health: A protocol for a systematic review and meta-analysis

BACKGROUND

Good communication strategies are essential in times of crisis, such as the coronavirus pandemic. The dissemination of inaccurate information and the need for social isolation to control coronavirus disease 2019 (COVID-19) have shown a negative impact on the population, causing damage to mental health, with the appearance or worsening of symptoms of stress, fear, anxiety, and depression. Thus, the systematic review study is intended to gather evidence on the impact of information about COVID-19 on the mental health of the population.

METHODS

This systematic review protocol is conducted using the guidelines of the preferred reporting items for systematic reviews and meta-analyses protocols and the Cochrane Handbook for Systematic Reviews of Interventions. The review aims to include published studies that address the exposure of the general population to information about COVID-19, through observational and experimental studies, which consider the following outcomes: fear, stress, anxiety, and depression. Thus, a comprehensive research strategy will be conducted in the following databases: PubMed / Medline, Scopus, Web of Science, EMBASE, Science Direct, CINAHL, PsycINFO and Cochrane Central Register of Controlled Trials (CENTRAL). Two independent reviewers will perform all procedures, such as study selection, data collection, and methodological evaluation. Disagreements will be forwarded to a third reviewer. RevMan 5.3 software will be used for data analysis.

RESULTS

This systematic review will provide evidence of the influence of access to and consumption of media and scientific information about COVID-19 on the mental health of the population. It will consider information about the characterization of the study and the population studied, clinical and epidemiological information on mental health, and data on access to and consumption of media and scientific information.

DISCUSSION

The results should inform about the consequences of communication about the new coronavirus on the emergence or worsening of psychological and psychiatric symptoms, allowing to develop strategies to achieve effective communication of information to promote the mental health of the population.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020182918.

Medical students' critical thinking assessment with collaborative concept maps in a blended educational Strategy

Background

Concept maps (CMs) are tools used to represent how new knowledge is integrated into the cognitive structure. In this study, we investigated the role of collaborative CMs in improving medical students' critical thinking and knowledge acquisition.

Methods

A pre-post interventional study was conducted. In the 1^st week of the clerkship rotation, a group of 10-14 students were asked by a faculty member to make a CM (CM1). After this first exposure (weeks 2/3), students learned the content through online forums. In the final week (week 4), students discussed what they had learned and made a final CM (CM2).

Results

A total of 104 students participated in the study, making twenty CM1 and twenty CM2. There was a statistically significant difference between CM1 and CM2 for overall scores, proposition units, and hierarchy units (P < 0.001).

Discussion

Collaborative CMs may be useful tools to help teachers better understand their students' critical thinking changes during a blended strategy.

Communication skills teaching in Brazilian medical schools: What lessons can be learned?

OBJECTIVE

To assess current practices in communication skills (CS) teaching in Brazilian medical schools (MS), looking for similarities and differences with other countries.

METHODS

This study was performed with 162 out of the 237 accredited Brazilian MS (68.35%). The quantitative data were analyzed using descriptive statistics and qualitative data using content analysis.

RESULTS

104 MS (64.2%) reported formal CS training. CS were more commonly taught in the pre-clinical years, by physicians and psychologists. Compared to other countries, Brazil was unique in offering training for "acolhimento" ("embracement"), which is a Brazilian Government strategy that requires that all those connected with healthcare delivery, from administrators to practitioners, and all allied health personnel "embrace" a dedication to caring for patients and the communities in which they live.

CONCLUSIONS

Formal CS teaching in Brazilian MS is less frequently seen in MS curriculum compared to reported data from other countries. The CS teaching of "embracement" is unique to Brazil.

PRACTICE IMPLICATIONS

This study adds to the literature by identifying the CS teaching of "embracement" in Brazilian MS, which could be considered outside Brazil.

Quality of Communication Questionnaire for COPD patients receiving palliative care: translation and cross-cultural adaptation for use in Brazil

Objective:

To translate the Quality of Communication Questionnaire (QOC) to Portuguese and adapt it for use in Brazil in COPD patients receiving palliative care.

Methods:

After approval from the first author of the original QOC and the local research ethics committee, the original, 13-item version of the questionnaire was independently translated to Brazilian Portuguese by two Brazilian translators fluent in English. The two translations were analyzed by a bilingual physician and the two Brazilian translators, who reached a consensus and produced another Portuguese version of the QOC. That version was back-translated to English by two translators originally from English-speaking countries and fluent in Portuguese. In order to resolve any discrepancies, an expert panel compared the original version of the QOC with all five versions produced up to that point, the “prefinal” version of the QOC for use in Brazil being thus arrived at. A total of 32 patients admitted to any of three public hospital ICUs in the greater metropolitan area of Florianopolis, in southern Brazil, participated in the pretesting phase of the study, which was aimed at assessing the clarity and cultural acceptability of the prefinal version of the QOC for use in Brazil.

Results:

Mean patient age was 48.5 ± 18.8 years. Most of the items were well understood and accepted, being rated 8 or higher. One item, regarding death, was considered difficult to understand by the participants in the pretesting phase. After analyzing the back-translated version of the QOC, the first author of the original questionnaire requested that the items “Caring about you as a human being” and “Talking about what death might be like” be changed to “Caring about you as a person” and “Talking about how dying might be”, respectively. The final version of the QOC for use in Brazil was thus arrived at.

Conclusions:

The QOC was successfully translated to Portuguese and adapted for use in Brazil.

Brazilian cross-cultural adaptation of the DocCom online module: communication for teamwork

ABSTRACT Objective: to carry out the cross-cultural adaptation of DocCom online module 38, which deals with teamwork communication into Portuguese for the Brazilian contexto. Method: the transcultural translation and adaptation were accomplished through initial translations, synthesis of the translations, evaluation and synthesis by a committee of experts, analysis by translators and back translation, pre-test with nurses and undergraduate students in Nursing, and analysis of the translators to obtain the final material. Results: in evaluation and synthesis of the translated version with the original version by the expert committee, the items obtained higher than 80% agreement. Few modifications were suggested according to the analysis by pretest participants. The final version was adequate to the proposed context and its purpose. Conclusion: it is believed that by making this new teaching-learning strategy of communication skills and competencies for teamwork available, it can be used systematically in undergraduate and postgraduate courses in the health area in Brazil in order to contribute to training professionals, and also towards making advances in this field.

Using Narratives to Create a Framework to Analyze Professional Growth of Third Year Medical Students

This article was migrated. The article was marked as recommended. Purpose: To create a framework for analyzing student narratives relating to professional growth in their third year of medical school. Method: Using a qualitative approach, we examined 32 student narratives in a professionalism course, and analyzed them in three phases: 1) open coding 2) categorical consolidation and 3) thematic analysis. Result: Three main themes were identified in third year student narratives: 1) Physician-Patient & Family Relationships 2) Learning Environment and 3) Self-Identity in Relationship to Teams. Based on student narratives the authors created a framework for narrative analysis referencing work from learning development theory and prior understanding of professional formation. Conclusion:A professional growth framework was developed using qualitative analysis of students' voices in self-reflection narratives during third year clinical clerkships. We believe this framework will be helpful to educators in understanding the process of professional formation and be useful as an analysis scheme for further studies of professional formation.

Empathy differences by gender and specialty preference in medical students: a study in Brazil

OBJECTIVE

We have conducted this study to assess medical students' empathy and to examine empathy differences by students' socio-demographic characteristics, including gender, and specialty preference.

METHODS

We have conducted a cross-sectional and descriptive research. Among 595 medical students registered at the Federal University of Santa Catarina (Brazil) in 2012, we have selected a sample of 320 enrolled in the first, third, fifth, seventh, ninth, eleventh, and in the last semester of the course. The response rate obtained was 70.6% (n=226). Data was collected by using a self-report questionnaire, and the variables analyzed included course semester, socio-demographic characteristics (such as age, gender, household monthly income and parents level of education), students' specialty preference, and empathy assessed by the Jefferson Scale of Empathy. We have used descriptive statistics, 95% Confidence Interval for percentages, Student's t-test, and Analysis of Variance to analyze the data.

RESULTS

Mean empathy among students was (M=119.7, SD=9.9), with no difference by according to semester (F=1.5, p=.2). Empathy means were higher among females (M=118.3, SD=10.6) than among males (M=121.0, SD=9.3, t=-2.1, p=.032). Students who preferred a people-oriented specialty obtained significantly higher mean scores (M=121.5, SD=8.1) in comparison to students who preferred technology-oriented specialties (M=118.0, SD=11.3, t=2.4, p=.02).

CONCLUSIONS

Our study has found consistently high scores of empathy among medical students enrolled in all levels of training at the Federal University of Santa Catarina, and higher empathy among women and students who intend to pursue a people-oriented specialty. Conclusions on higher empathy among medical students require further study.

Educação interprofissional no Programa PET-Saúde: a percepção de tutores

O PET-Saúde da Universidade Federal de Minas Gerais (UFMG) foi a primeira experiência institucional de educação pelo trabalho em grupos tutoriais interprofissionais na atenção básica, envolvendo todos os cursos da saúde. Foi desenvolvido em centros de saúde de Belo Horizonte, Brasil, entre 2009 a 2011. O objetivo deste estudo foi compreender como os docentes/tutores do PET-Saúde da UFMG perceberam a Educação Interprofissional (EIP) presente no PET-Saúde, a partir da narrativa de 14 tutores do PET-Saúde. A maioria dos docentes foi favorável ao processo de ensino-aprendizagem em grupos interprofissionais no serviço, mesmo considerando a experiência desafiadora. O estudo identificou elementos importantes e nos permite considerar o PET-Saúde na UFMG como inovação educacional exitosa, e a atenção básica um contexto favorável para a educação interprofissional.

How Do Medical Schools Identify and Remediate Professionalism Lapses in Medical Students? A Study of U.S. and Canadian Medical Schools

PURPOSE

Teaching and assessing professionalism is an essential element of medical education, mandated by accrediting bodies. Responding to a call for comprehensive research on remediation of student professionalism lapses, the authors explored current medical school policies and practices.

METHOD

In 2012-2013, key administrators at U.S. and Canadian medical schools accredited by the Liaison Committee on Medical Education were interviewed via telephone or e-mail. The structured interview questionnaire contained open-ended and closed questions about practices for monitoring student professionalism, strategies for remediating lapses, and strengths and limitations of current systems. The authors employed a mixed-methods approach, using descriptive statistics and qualitative analysis based on grounded theory.

RESULTS

Ninety-three (60.8%) of 153 eligible schools participated. Most (74/93; 79.6%) had specific policies and processes regarding professionalism lapses. Student affairs deans and course/clerkship directors were typically responsible for remediation oversight. Approaches for identifying lapses included incident-based reporting and routine student evaluations. The most common remediation strategies reported by schools that had remediated lapses were mandated mental health evaluation (74/90; 82.2%), remediation assignments (66/90; 73.3%), and professionalism mentoring (66/90; 73.3%). System strengths included catching minor offenses early, emphasizing professionalism schoolwide, focusing on helping rather than punishing students, and assuring transparency and good communication. System weaknesses included reluctance to report (by students and faculty), lack of faculty training, unclear policies, and ineffective remediation. In addition, considerable variability in feedforward processes existed between schools.

CONCLUSIONS

The identified strengths can be used in developing best practices until studies of the strategies' effectiveness are conducted.

Use of Psychodrama in medicine in Brazil: a review of the literature

Objective To review the literature on experiences of the use of psychodrama in medical education in Brazil. Methods Papers published between 2003 and 2013 were identified in the main databases. Results Seven papers were identified. Role playing and sociodrama were the psychodrama techniques reported. They were used to address aspects of relationships such as emotions and behavior and to improve some communication and clinical skills. Psychodrama provided the students with opportunities for critical reflection, questioning of professional practices and sharing of experiences, and also decreased their anxiety and fear. Role playing was used among students and among teachers undergoing academic development, while sociodrama was only used among students. Conclusions There are still few papers reporting on experiences from the use of psychodrama in Brazilian medical schools.

Preserving third year medical students' empathy and enhancing self-reflection using small group "virtual hangout" technology

BACKGROUND

Medical student professionalism education is challenging in scope, purpose, and delivery, particularly in the clinical years when students in large universities are dispersed across multiple clinical sites. We initiated a faculty-facilitated, peer small group course for our third year students, creating virtual classrooms using social networking and online learning management system technologies. The course emphasized narrative self-reflection, group inquiry, and peer support.

METHODS

We conducted this study to analyze the effects of a professionalism course on third year medical students' empathy and self-reflection (two elements of professionalism) and their perceptions about the course. Students completed the Groningen Reflection Ability Scale (GRAS) and the Jefferson Scale of Empathy (JSE) before and after the course and provided anonymous online feedback.

RESULTS

The results of the JSE before and after the course demonstrated preservation of empathy rather than its decline. In addition, there was a statistically significant increase in GRAS scores (p < 0.001), suggesting that the sharing of personal narratives may foster reflective ability and reflective practice among third year students.

CONCLUSION

This study supports previous findings showing that students benefit from peer groups and discussion in a safe environment, which may include the use of a virtual group video platform.

Residents' and standardized patients' perspectives on empathy: issues of agreement

OBJECTIVE

We investigated correlations between residents' scores on the Jefferson Scale of Empathy (JSE), residents' perceptions of their empathy during standardized-patient encounters, and the perceptions of standardized patients.

METHODS

Participants were 214 first-year residents in internal medicine or family medicine from 13 residency programs taking standardized patient-based clinical skills assessment in 2011. We analyzed correlations between residents' JSE scores; standardized patients' perspectives on residents' empathy during OSCE encounters, using the Jefferson Scale of Patient Perceptions of Physician Empathy; and residents' perspectives on their own empathy, using a modified version of this scale.

RESULTS

Residents' JSE scores correlated with their perceptions of their own empathy during encounters but correlated poorly with patients' assessments of resident empathy.

CONCLUSION

The poor correlation between residents' and standardized patients' assessments of residents' empathy raises questions about residents' abilities to gauge the effectiveness of their empathic communications. The study also points to a lack of congruence between the assessment of empathy by standardized patients and residents as receivers and conveyors of empathy, respectively.

PRACTICE IMPLICATIONS

This study adds to the literature on empathy as a teachable skill set and raises questions about use of OSCEs to assess trainee empathy.

Distribuição da gordura corporal em escolares: um estudo usando o método LMS

INTRODUÇÃO: A avaliação do sobrepeso e obesidade em populações ainda tem sido baseada predominantemente no índice de massa corporal, o qual tem sido considerado o indicador universal da adiposidade. OBJETIVO: Analisar a distribuição da gordura corporal de escolares de sete a 10 anos, por meio da construção de referenciais percentílicos das dobras cutâneas, utilizando os parâmetros LMS. MÉTODO: Os dados são relativos a uma amostra representativa de escolares de sete a 10 anos frequentando escolas públicas e privadas, que participaram de pesquisa mais ampla de prevalência do sobrepeso e obesidade, realizada em 2002, em Florianópolis (Santa Catarina, Brasil), e composta por 2.918 crianças. Para este estudo utilizaram-se os dados antropométricos de estatura, dobras cutâneas subescapular, suprailíaca, tricipital e panturrilha medial. O método LMS, que visa normalizar os dados que apresentam assimetria em sua distribuição, foi utilizado para analisar e comparar a distribuição das dobras por faixa etária e sexo. RESULTADOS: Ambos os sexos apresentaram valores maiores de gordura subcutânea na região do tríceps e da panturrilha, porém, no sexo masculino estes foram inferiores aos das meninas e com pouco incremento ao longo da faixa etária investigada. A dobra que apresentou maior incremento nos valores medianos foi a suprailíaca, para o sexo feminino, a qual alcançou valores próximos aos da dobra tricipital aos 10 anos de idade. CONCLUSÕES: O método LMS propicia a análise da distribuição dos valores das dobras cutâneas, as quais são importantes para avaliar a evolução da gordura corporal e o estado nutricional de crianças.

Ethical problems in pediatrics: what does the setting of care and education show us?

Background

Pediatrics ethics education should enhance medical students' skills to deal with ethical problems that may arise in the different settings of care. This study aimed to analyze the ethical problems experienced by physicians who have medical education and pediatric care responsibilities, and if those problems are associated to their workplace, medical specialty and area of clinical practice.

Methods

A self-applied semi-structured questionnaire was answered by 88 physicians with teaching and pediatric care responsibilities. Content analysis was performed to analyze the qualitative data. Poisson regression was used to explore the association of the categories of ethical problems reported with workplace and professional specialty and activity.

Results

210 ethical problems were reported, grouped into five areas: physician-patient relationship, end-of-life care, health professional conducts, socioeconomic issues and health policies, and pediatric teaching. Doctors who worked in hospitals as well as general and subspecialist pediatricians reported fewer ethical problems related to socioeconomic issues and health policies than those who worked in Basic Health Units and who were family doctors.

Conclusions

Some ethical problems are specific to certain settings: those related to end-of-life care are more frequent in the hospital settings and those associated with socioeconomic issues and public health policies are more frequent in Basic Health Units. Other problems are present in all the setting of pediatric care and learning and include ethical problems related to physician-patient relationship, health professional conducts and the pediatric education process. These findings should be taken into consideration when planning the teaching of ethics in pediatrics.

Trial registration

This research article didn't reports the results of a controlled health care intervention. The study project was approved by the Institutional Ethical Review Committee (Report CEP-HIJG 032/2008).

[Practices and meanings of oral health: a qualitative study with mothers of children assisted at the Federal University of Santa Catarina]

This research aimed to know oral health practices and meanings of mothers whose children were attended in the dental pediatric clinics of the Federal University of Santa Catarina. The qualitative method, case study, was used and data were collected by semi-structured interview. The studied population consisted of seven mothers that took their children to odontologic attendance at the university. It was observed that despite previous negative odontologic experiences, economic difficulties and pregnancy have also influenced those mothers to look for and adhere to dental care. The dental visits occurred, mostly, for curative assistance. The mothers took care of their children's teeth because it was considered a maternal responsibility, to prevent dental caries and their consequences, to avoid wasting money with expensive treatment and children's bad experiences with dentists. Mothers received information on the subject from dentists, doctors, nurses, schools, mass communication media and odontology students. Despite of their desire in taking care adequately of their children's health, those mothers don't always have favorable socio-economic conditions to put the obtained instructions into practice.

Uso de terapias complementares por mães em seus filhos: estudo em um hospital universitário

O objetivo deste estudo é avaliar a utilização de terapias complementares (TC) por mães em seus filhos. Trata-se de um estudo transversal, descritivo. Foram entrevistadas 202 mães de crianças assistidas em um hospital universitário. As variáveis analisadas foram: uso de terapias complementares/motivos para tal, tipos de terapias utilizadas, sua finalidade, seus efeitos, revelação ao médico/motivos para tal e reação do médico. A prevalência de uso de terapias complementares foi 87,6%. De 177 mães que utilizavam TC, muitas mencionaram mais de um tipo, sendo: chás (72,8%), benzimento (41%), simpatias (12,9%), remédios/xaropes caseiros (8,4%), oração/promessa (7,4%), homeopatia (4,0%), tratamento espiritual/parapsicológico (4,0%), mistura de substâncias desconhecidas/garrafada (3%), massagem (2%) e reiki/florais (1,5%). As ervas mais utilizadas foram erva-doce (16,7%), camomila (14,8%) e hortelã (10,9%); 57,6% das mães não informaram o uso ao médico. Dos 499 tratamentos empregados, houve percepção de melhora em 429 (86%) e relato de dois casos de efeitos adversos. A prevalência do uso de terapias complementares foi alta, sendo os chás a terapia mais utilizada e erva-doce, camomila e hortelã as ervas mais usadas. Houve percepção de melhora na maioria das terapias usadas.

Satisfação com o atendimento odontológico: estudo qualitativo com mães de crianças atendidas na Universidade Federal de Santa Catarina

Esta pesquisa objetivou conhecer a percepção de mães em relação ao atendimento odontológico prestado em clínicas de odontopediatria da Universidade Federal de Santa Catarina (UFSC), bem como sua concepção sobre como seria o dentista "ideal". O método utilizado foi o qualitativo, tipo estudo de caso. A coleta de dados foi feita através de entrevista semi-estruturada e a população estudada constituiu-se de sete mães de crianças atendidas em clínicas de odontopediatria da UFSC. Observou-se que, para as mães entrevistadas, o dentista ideal deveria reunir habilidades afetivas, psicomotoras e cognitivas, tais como: gostar do que faz, ser atencioso e amigável, fornecer informações claras sobre saúde bucal, resolver os problemas bucais do paciente e manter-se atualizado. Os aspectos interpessoais foram fundamentais para a satisfação com o atendimento na universidade, além da capacidade técnica dos alunos e a facilidade para conseguir uma vaga no serviço de odontopediatria. Sugere-se maior entendimento, por parte dos profissionais, dos aspectos que envolvem a relação dentista-paciente, de maneira a associar fatores afetivos aos cognitivos e psicomotores no dia-a dia da prática odontológica.

Central adiposity in Brazilian schoolchildren aged 7-10 years

Waist circumference (WC) is a measure of central adiposity related to elevated risk factor levels in children and adolescents. The aim of the present study was to describe WC percentiles in 7- to 10-year-old Brazilian children and to compare frequencies of obesity and overweight as defined by BMI and frequencies of excess and at risk of abdominal adiposity as defined by WC to the corresponding age and sex data from British references. A representative sample of 2919 schoolchildren of the city of Florianopolis (southern Brazil) was examined. Smoothed WC percentiles were derived using the least mean square method. Frequencies of overweight and obesity and of excess and at risk of abdominal adiposity were assessed using the 91st and 98th centiles of the British references as cut-off points. WC increased with age in both boys and girls, with higher values for boys at every age and percentile level. Nutritional status categories of children assessed by the 91st and 98th British BMI and WC centiles showed moderate agreement (weighted kappa = 0.58). Overweight was more frequent in Brazilian than British children: 15.1 % of girls and 20.1 % of boys were above the 91st percentile of the 1990 BMI for age British references. About one-quarter (22.0 % of girls and 26.9 % of boys) exceeded the 91st percentile of WC British references. The present data could be used to compare WC in children in other populations and may serve as a baseline for future studies of temporal trends in WC in Brazil.

Overweight and thinness in 7-9 year old children from Florianópolis, Southern Brazil: a comparison with a French study using a similar protocol

OBJECTIVE: To assess nutritional status based on weight and height variables in children aged 7-9-y-old in a city from the South of Brazil (Florianópolis) and to compare the prevalence of thinness and overweight and environmental factors between Brazil and France. METHODS: Randomly stratified samples of 7-9 y-old children (Florianópolis, n= 2.232; France, n= 1.582). Both studies followed the protocol recommended by the European Childhood Obesity Group. Weight and height were recorded according to World Health Organization recommendation. Thinness and overweight were defined using the French references. Physical activity and sedentary behaviors were compared. RESULTS: Florianópolis children were taller and heavier than the French. The frequency of thinness was lower in Florianópolis as compared to France (1.1 vs 3.9%). Overweight frequency was 19.9% in Florianópolis as compared to 16.3% in France. French children had a higher level of physical activity. In particular, 66.5% of French children had a regular sport activity compared to 35.7% in Florianópolis. In France, daily television and screen viewing time was 2 hours per day as compared to 3.3 hours in Brazil. CONCLUSION: Behavioral parameters, particularly sedentary lifestyle, could account for the higher prevalence of overweight in Brazilian children. Strategies to decrease the prevalence of overweight in children should take into account the particularities of each country.

Obesity, overweight and thinness in schoolchildren of the city of Florianópolis, Southern Brazil

OBJECTIVE

To assess the prevalence of obesity, overweight (including obesity) and thinness in children of the city of Florianopolis (southern Brazil).

DESIGN

Cross-sectional study.

SUBJECTS

Representative sample of 7-10-y-old schoolchildren of the first four grades of elementary schools (1432 girls, 1504 boys).

METHODS

Measurements of weight, height and triceps skinfold thickness (TSF) were taken following standard techniques. The body mass index (BMI) was computed as weight/height2. Nutritional status was defined using two references: (1) the Must et al reference for BMI and TSF to define thinness, overweight and obesity (5th, 85th and 95th percentiles, respectively); (2) the International Obesity Task Force (IOTF) BMI cutoffs to define overweight and obesity.

RESULTS

Using BMI, according to the Must et al, and IOTF references, the prevalence of obesity was 10.6 and 5.5%, respectively; overweight (including obesity) affected 26.2 and 22.1% of children, respectively. According to the Must et al reference, the prevalence of thinness was 3.2%. Using TSF rather than BMI, according to the Must et al references, fewer children were classified as obese (8.0%) or overweight (20.2%) and more children were classified as thin (4.9%).

CONCLUSION

This study supports the previously reported high frequencies of childhood overweight and obesity in developing countries. The data allow comparisons with other studies carried out in Brazil and other parts of the world.

Prevalência de sobrepeso e obesidade em escolares de uma escola pública de Florianópolis, Santa Catarina

OBJETIVOS: determinar a prevalência de sobrepeso e obesidade em escolares de sete a nove anos de uma escola pública de Florianópolis. MÉTODOS: foram investigadas 419 crianças entre sete e nove anos de idade, sendo 215 (51,3%) do sexo masculino e 204 (48,7%) do feminino. Como critério diagnóstico de sobrepeso e obesidade foram utilizados os pontos de corte de Índice de Massa Corporal (IMC). Para a verificação das diferenças entre prevalências utilizou-se o teste qui-quadrado. RESULTADOS: encontrou-se prevalência de 17,9% de sobrepeso, sendo maior no sexo masculino (19,1%) do que no feminino (16,7%) e 6,7% de obesidade, com maiores valores no sexo masculino (7,9%) do que no feminino (5,4%), embora a diferença não tenha sido estatisticamente significante. Observou-se maior prevalência de sobrepeso entre as crianças de oito anos (20,4%) e a maior prevalência de obesidade entre aquelas de nove anos (6,8%). Considerando-se faixa etária e sexo a maior prevalência de sobrepeso foi no sexo feminino aos oito anos e de obesidade no sexo masculino aos sete anos de idade. CONCLUSÕES: verificou-se uma elevada prevalência de sobrepeso e obesidade, quando comparada a outros estudos nacionais e internacionais. Esses achados apontam para a adoção de medidas de intervenção nutricional visando à melhoria dos hábitos alimentares e do estado nutricional dos escolares investigados.