Continuing Education in Health: interprofessional practices in the field of Collective Health

Family Health Support Centres (NASFs, in Portuguese) aim to develop interprofessional practices anchored in the assumptions of Primary Health Care, guided by the criteria of shared care specific professional interventions, management processes, interdisciplinarity, intersectoriality, Continuing Education in Health and health promotion. This health management methodology (Matrix Support) still represents a challenge to workers and managers, as it switches the logic of clinical thought from individual-centred, ambulatory and disciplinary care to collective, territory and interdisciplinary care. This study might illustrate and allow sharing of experiences about a work management format for multidisciplinary teams in Primary Health Care. A partnership between the University and the state health department was established in order to elaborate a collaborative, educational and supportive action. We formed a group of workers in the target area (24 municipalities and 18 teams) who had a focus on Continuing Education in Health using Institutional Analysis as theoretical reference. The main goal of the action was to provide spaces to share experiences and learning in the perspective of Continuing Education in Health. How does Continuing Education in Health support interprofessional practices in the field of Collective Health? Among the main results, we list: reflection about organisation practices of multiprofessional work, reflection about care practices and clinic management in the technical-assistance and pedagogic perspectives of Matrix Support; encouragement to improve the services offered in this level of care and their relationship with other points of the network. This experience showed us the importance of three main aspects: Continuing Education in Health, as a strategy of critical analysis about work and workers; the partnership and integration between teaching and service; and interprofessional formation processes (necessary to NASF and Collective Health).

Key messages

Continuing Education in Health is a strategy to deal with challenges and possibilities of interprofessional practices in the field of Collective Health. Enabling experiences and providing spaces for health professionals to share experience and learning.

O Uso do Laser de CO2 na Remoção de Bráquetes Cerâmicos

Este estudo tem como objetivo analisar a utilização do laser de CO2 na remoção de bráquetes cerâmicos, por meio de uma revisão de literatura. Utilizando-se as bases de dados Medline via PubMed, Science Direct e SciELO, e os descritores “lasers”, “dental debonding” e “orthodontic brackets” combinados, buscou-se artigos publicados no período de 2007 a 2017. De 133 artigos elegíveis, selecionaram-se nove, por atenderem aos seguintes critérios de inclusão: ser estudo in vitro, utilizar o laser do tipo CO2. Foram excluídas todas as revisões de literatura. Entre os artigos selecionados, cinco abordaram a relação do descolamento do bráquete cerâmico com as fraturas de esmalte, mostrando que, com o emprego do laser de CO2, há uma redução significativa dos riscos de danos e fraturas nessa estrutura. Seis artigos deram enfoque à relação do uso do laser de CO2 no descolamento do bráquete com    a variação da temperatura pulpar, constatando que esse tipo de laser não apresenta risco de dano térmico à polpa, uma vez que o aumento de temperatura após a aplicação do método variou entre 1,48 °C e 4,9 °C, de acordo com a potência do aparelho utilizado. Por fim, seis artigos ressaltaram o Índice de Remanescente Adesivo (IRA), após a remoção do dispositivo, constatando que houve pequena variação comparada ao grupo controle. Conclui-se, pois, que, segundo a literatura consultada, a utilização do laser de CO2 na remoção de bráquetes cerâmicos reduz satisfatoriamente a força de união desse dispositivo ao esmalte dental, contribuindo para sua remoção, sem que haja um aumento excessivo da temperatura.Palavras-chave: Lasers. Descolagem Dentária. Bráquetes Ortodônticos.

MRI Texture Analysis Reveals Bulbar Abnormalities in Friedreich Ataxia

BACKGROUND AND PURPOSE

Texture analysis is an image processing technique that can be used to extract parameters able to describe meaningful features of an image or ROI. Texture analysis based on the gray level co-occurrence matrix gives a second-order statistical description of the image or ROI. In this work, the co-occurrence matrix texture approach was used to extract information from brain MR images of patients with Friedreich ataxia and a control group, to see whether texture parameters were different between these groups. A longitudinal analysis was also performed.

MATERIALS AND METHODS

Twenty patients and 21 healthy controls participated in the study. Both groups had 2 sets of T1-weighted MR images obtained 1 year apart for every subject. ROIs chosen for analysis were the medulla oblongata and pons. Texture parameters were obtained for these ROIs for every subject, for the 2 sets of images. These parameters were compared longitudinally within groups and transversally between groups.

RESULTS

The comparison between patients and the control group showed a significant differences for the medulla oblongata (t test, P < .05, Bonferroni-corrected) but did not show a statistically significant difference for the pons. Longitudinal comparison of images obtained 1 year apart did not show differences for either patients or for controls, in any of the analyzed structures.

CONCLUSIONS

Gray level co-occurrence matrix-based texture analysis showed statistically significant differences for the medulla oblongata of patients with Friedreich ataxia compared with controls. These results highlight the medulla as an important site of damage in Friedreich ataxia.

Experiencing genetic counselling for hereditary cancers: the client's perspective

As genetic health care expands and genetic testing becomes more widely available, it becomes relevant to understand how individuals involved in genetic counselling are integrating this new information in health management and into their lives. This article examines the client's experiences of genetic counselling for hereditary cancers, which definitely play a major role in the assessment of their needs and also lead to improvement of the psychosocial focus in genetic counselling protocols. Methods include a semi-structured interview, administered in two focus groups, comprising 10 (5 + 5) participants after attending genetic counselling for hereditary cancers at a Portuguese public hospital. Findings suggest an experience embedded in two dimensions: (1) instrumental (goals, needs and decision making); and (2) emotional (uncertainty regarding genetic risk screening and an emotional complex). Ambiguity plays a crucial role, especially in two moments: (1) the hiatus between genetic testing and the screening results; and (2) after being confirmed as carrying a cancer susceptibility gene mutation. The spectrum of genetic illness comprises an intensely complex emotional experience that challenges individuals and their families in terms of health management, and personal and family planning. Recommendations are included in order to enhance the services available by expanding psychosocial support.