RESUMO
Objective: To grade the evidence about risk factors for eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder) with an umbrella review approach. Methods: This was a systematic review of observational studies on risk factors for eating disorders published in PubMed/PsycInfo/Embase until December 11th, 2019. We recalculated random-effect meta-analyses, heterogeneity, small-study effect, excess significance bias and 95% prediction intervals, grading significant evidence (p < 0.05) from convincing to weak according to established criteria. Quality was assessed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. Results: Of 2,197 meta-analyses, nine were included, providing evidence on 50 risk factors, 29,272 subjects with eating disorders, and 1,679,385 controls. Although no association was supported by convincing evidence, highly suggestive evidence supported the association between childhood sexual abuse and bulimia nervosa (k = 29, 1,103 cases with eating disorders, 8,496 controls, OR, 2.73, 95%CI 1.96-3.79, p = 2.1 x 10-9, AMSTAR-2 moderate quality) and between appearance-related teasing victimization and any eating disorder (k = 10, 1,341 cases with eating disorders, 3,295 controls, OR 2.91, 95%CI 2.05-4.12, p = 1.8x10-9, AMSTAR-2 moderate quality). Suggestive, weak, or no evidence supported 11, 29, and 8 associations, respectively. Conclusions: The most credible evidence indicates that early traumatic and stressful events are risk factors for eating disorders. Larger collaborative prospective cohort studies are needed to identify risk factors for eating disorders, particularly anorexia nervosa.
Assuntos
Humanos , Criança , Anorexia Nervosa/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Bulimia Nervosa/epidemiologia , Estudos Prospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To grade the evidence about risk factors for eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder) with an umbrella review approach. METHODS: This was a systematic review of observational studies on risk factors for eating disorders published in PubMed/PsycInfo/Embase until December 11th, 2019. We recalculated random-effect meta-analyses, heterogeneity, small-study effect, excess significance bias and 95% prediction intervals, grading significant evidence (p < 0.05) from convincing to weak according to established criteria. Quality was assessed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. RESULTS: Of 2,197 meta-analyses, nine were included, providing evidence on 50 risk factors, 29,272 subjects with eating disorders, and 1,679,385 controls. Although no association was supported by convincing evidence, highly suggestive evidence supported the association between childhood sexual abuse and bulimia nervosa (k = 29, 1,103 cases with eating disorders, 8,496 controls, OR, 2.73, 95%CI 1.96-3.79, p = 2.1 x 10-9, AMSTAR-2 moderate quality) and between appearance-related teasing victimization and any eating disorder (k = 10, 1,341 cases with eating disorders, 3,295 controls, OR 2.91, 95%CI 2.05-4.12, p = 1.8x10-9, AMSTAR-2 moderate quality). Suggestive, weak, or no evidence supported 11, 29, and 8 associations, respectively. CONCLUSIONS: The most credible evidence indicates that early traumatic and stressful events are risk factors for eating disorders. Larger collaborative prospective cohort studies are needed to identify risk factors for eating disorders, particularly anorexia nervosa.
Assuntos
Anorexia Nervosa , Bulimia Nervosa , Transtornos da Alimentação e da Ingestão de Alimentos , Anorexia Nervosa/epidemiologia , Bulimia Nervosa/epidemiologia , Criança , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Humanos , Estudos Prospectivos , Fatores de RiscoRESUMO
In the last decades, a series of studies has explored the role of morphological awareness on reading comprehension. Path analysis studies performed in English have shown that morphological awareness benefits reading comprehension both directly and indirectly, through word decoding. This issue has seldom been explored in Spanish. The aim of this study was to replicate in Spanish the results previously found in English. We used path analysis to assess three alternative models of the relationship between morphological awareness, word decoding and reading comprehension in 4th grade Spanish-speaking children. Contrary to English, we found that morphological awareness benefits reading comprehension only directly. We conclude that in Spanish, in which accurate and fluent pronunciation of written words can be achieved through grapheme-to-phoneme conversion rules, morphological awareness does not help the correct pronunciation of words. Thus, morphological awareness is not relevant for word decoding in Spanish but is related to reading comprehension since this type of morphological knowledge provides access to the semantic and syntactic information of new words.
Assuntos
Conscientização/fisiologia , Compreensão/fisiologia , Desenvolvimento da Linguagem , Psicolinguística , Leitura , Argentina , Criança , Feminino , Humanos , MasculinoRESUMO
Several studies in Spanish and other languages have shown that, in a lexical decision task, children are more likely to accept pseudowords with a known morphological structure as words as compared to non-morphological pseudowords. Morphology also facilitates visual word recognition of actual words in children with reading difficulties. In the present study, we explored the role of morphology, frequency and reading proficiency (measured by school grade) in visual word recognition. Typically developing readers of Spanish from 2nd, 4th and 6th grades performed a lexical decision task in which the morphological complexity and the frequency of the words were factorially manipulated. Our results showed that morphology benefited the accuracy of visual word recognition for low frequency words only. We conclude that decomposition in morphemes occurs in Spanish only for less frequent words. These results in Spanish support models that posit the decomposition of morphologically complex words in the orthographic lexicon.
Assuntos
Reconhecimento Visual de Modelos/fisiologia , Psicolinguística , Reconhecimento Psicológico/fisiologia , Argentina , Criança , Feminino , Humanos , MasculinoRESUMO
Abstract The More Doctors Program (PMM) was created in 2013 to address problems such as the insufficient number and unequal distribution of doctors, and their inadequate education profile to fulfill the population needs. Among other axes, it proposes changes in medical education, including the rearrangement and expansion of residency, suggesting one seat for every medical course graduate. This study reflects upon the elements that were essential to propose and implement changes in medical residency through PMM. The following advances were identified: better distribution of residency seats across Brazil; diversification of universalization strategies; regulations for residency seats focused on Family and Community Medicine; and preceptorship qualification. The conclusion section presents the challenges faced by the required institutional effort to maintain PMM's actions in order to regulate residency and expand actions to other professions.(AU)
Resumo O Programa Mais Médicos (PMM) foi criado em 2013 para enfrentar problemáticas como a insuficiência e má distribuição de médicos e o perfil de formação inadequado às necessidades da população. Entre os seus eixos está a mudança da formação médica, incluindo a reordenação e ampliação da residência, propondo uma vaga para cada egresso dos cursos de Medicina. Neste artigo, propõe-se uma reflexão sobre quais elementos foram decisivos na formulação e implementação das mudanças na residência médica pelo PMM. Identificam-se: melhor distribuição de vagas de residência entre as regiões do país; diversificação de estratégias para universalização do acesso à residência médica; regulação das vagas de residência médica com enfoque na Medicina de Família e Comunidade; e qualificação da preceptoria. Na conclusão são apontados desafios enfrentados pelo esforço institucional necessário de manter as ações do PMM visando regular a residência e expandir ações para mais profissões.(AU)
Resumen El Programa Más Médicos, creado en 2013, buscaba enfrentar problemáticas como la insuficiencia y mala distribución de médicos y el inadecuado perfil de formación para las necesidades poblacionales en Brasil. Sus ejes buscan cambios en la formación médica, reorganización y ampliación de residencias, y proponer una plaza para cada egresado del curso de medicina. Este artículo analiza documentación, bases de datos oficiales y revisa la literatura buscando evaluar propuestas y objetivos alcanzados por el programa en las residencias. Se identificaron avances importantes en: la distribución de plazas de residencia en las regiones del país, la interiorización de la formación, la regulación de las plazas de residencia médica con enfoque en medicina de familia y comunidad y la cualificación de la preceptoría. La conclusión señala los desafíos enfrentados por el programa para alcanzar efectivamente sus objetivos.(AU)
Assuntos
Humanos , Consórcios de Saúde , Medicina de Família e Comunidade , Internato e Residência/tendências , Atenção Primária à SaúdeRESUMO
OBJECTIVE: To develop and validate a diagnostic score that assists in discriminating primary hemophagocytic lymphohistiocytosis (pHLH) from macrophage activation syndrome (MAS) related to systemic juvenile idiopathic arthritis. STUDY DESIGN: The clinical, laboratory, and histopathologic features of 362 patients with MAS and 258 patients with pHLH were collected in a multinational collaborative study. Eighty percent of the population was assessed to develop the score and the remaining 20% constituted the validation sample. Variables that entered the best fitted model of logistic regression were assigned a score, based on their statistical weight. The MAS/HLH (MH) score was made up with the individual scores of selected variables. The cutoff in the MH score that discriminated pHLH from MAS best was calculated by means of receiver operating characteristic curve analysis. Score performance was examined in both developmental and validation samples. RESULTS: Six variables composed the MH score: age at onset, neutrophil count, fibrinogen, splenomegaly, platelet count, and hemoglobin. The MH score ranged from 0 to 123, and its median value was 97 (1st-3rd quartile 75-123) and 12 (1st-3rd quartile 11-34) in pHLH and MAS, respectively. The probability of a diagnosis of pHLH ranged from <1% for a score of <11 to >99% for a score of ≥123. A cutoff value of ≥60 revealed the best performance in discriminating pHLH from MAS. CONCLUSION: The MH score is a powerful tool that may aid practitioners to identify patients who are more likely to have pHLH and, thus, could be prioritized for functional and genetic testing.
Assuntos
Linfo-Histiocitose Hemofagocítica/diagnóstico , Síndrome de Ativação Macrofágica/diagnóstico , Adolescente , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Masculino , Reprodutibilidade dos TestesRESUMO
Em 2013, chegaram os primeiros médicos pelo Programa Mais Médicos. O seu processo de implantação foi cercado de disputas judiciais e embates ideológicos advindos de médicos brasileiros e suas entidades representativas. A iniciativa de criação do programa foi creditada pelas entidades médicas como uma medida unilateral do Governo Federal, eleitoreira e sem planejamento. O artigo resgata o processo histórico que deu origem ao Programa Mais Médicos, destacando a tensão entre governo e entidades médicas. Trata-se de estudo exploratório com pesquisa bibliográfica e documental. Analisando dados e tendências nacionais e internacionais e discursos de médicos e suas entidades representativas, é possível inferir que o programa não está sendo compreendido na sua totalidade, que vai além da provisão imediata de médicos. Além disso, o papel regulador do Estado para cumprir a Constituição Federal está sendo confundido com interferência na autonomia da profissão médica.(AU)
In 2013, the first physicians arrived for the More Doctors Program. The process of implementation was engulfed in legal disputes and ideological conflicts sparked by Brazilian physicians and their representative associations. The initiative to create the program was seen by the medical associations as a unilateral measure of the federal government, lacking in planning and designed to win votes. This paper presents the historical process that gave rise to the program, highlighting the tension between the government and medical associations. It is an exploratory study with biographical and documental research. Through analyzing data and national and international trends, as well as statements from physicians and their representative associations, it can be inferred that the program is not understood in its entirety, which goes beyond the immediate provision of physicians. In addition, the regulatory role of the State, in its responsibility to comply with the Federal Constitution, is being misinterpreted as undermining the autonomy of the medical profession.(AU)
En 2013 llegaron los primeros médicos del Programa Más Médicos. Su proceso de implantación estuvo cargado por disputas judiciales y embates ideológicos provenientes de médicos brasileños y sus entidades representativas. La iniciativa de creación del Programa fue considerada por las entidades médicas como una medida unilateral del Gobierno Federal, con fines electorales y sin planificación. El artículo rescata el proceso histórico que dio origen al Programa, destacando la tensión entre gobierno y entidades médicas. Se trata de un estudio exploratorio con investigación bibliográfica y documental. Analizando datos y tendencias nacionales e internacionales y discursos de médicos y sus entidades representativas, es posible inferir que el Programa no se ha entendido en su totalidad, que va más allá de la provisión inmediata de médicos. Además, el papel regulador del estado para cumplir la Constitución Federal se está confundiendo con interferencia en la autonomía de la profesión médica.(AU)
Assuntos
Humanos , Mão de Obra em Saúde , Planejamento em Saúde , Programas Nacionais de Saúde , Distribuição de Médicos , Política de Saúde , Brasil , Internato e Residência , Avaliação de Programas e Projetos de SaúdeRESUMO
Resumo Até recentemente, inexistiam políticas indutoras da formação de especialistas voltadas ao SUS. Um marco foi o Programa Nacional de Apoio à Formação de Médicos Especialistas em Áreas Estratégicas - Pró-Residência, criado em 2009. Com o lançamento do Programa Mais Médicos pela Lei nº12.871/2013, novas estratégias se configuraram para aprimorar a regulação da formação de especialistas. Este artigo pretende discutir as políticas de regulação da abertura de vagas de residência médica a partir do Pró-Residência e abordar mudanças apontadas pela Lei nº 12.871/2013, como a universalização das vagas com ênfase para Medicina de Família e Comunidade. Foi realizada pesquisa bibliográfica com análise documental, além de estudo quantitativo. Os resultados evidenciam efeitos positivos de políticas públicas no número e distribuição de vagas de residência médica com a duplicação destas entre 2009 e 2014, aumento mais expressivo nas regiões Norte e Nordeste, além do surgimento de especialidades antes inexistentes nessas regiões. Novos desafios se colocam para expandir a residência com velocidade e qualidade necessárias, como a melhoria de ferramentas para a gestão de recursos humanos em saúde, com expansão e qualificação da preceptoria e campos de prática para formação.
Abstract Until recently, there were no policies that induce the formation of specialists geared to the Unified Heath System (SUS). A milestone was the National Program to Support Training of Medical Specialists in Strategic Areas - Pro-Residência, created in 2009. With the launch of the Mais Médicos Program by Law n. 12.871/2013, new strategies were shaped to enhance the regulation of training specialists. This article discusses the regulatory policies of the opening of medical residency positions from the Pro-Residência and addresses changes suggested by Law n. 12.871/2013 such as universal vacancies with emphasis on Family Medicine. This is a quantitative and qualitative study that uses bibliographic and documentary research. The results show the positive effects of public policies in the number and distribution of medical residency positions. The number of professionals has been doubled between 2009 and 2014 with more significant increase in the North and Northeast regions. Furthermore, there is also the emergence of specialties previously nonexistent in these regions. New challenges arise to expand residency with necessary quality and speed, such as improved tools for the management of health human resources, with expansion and qualification of preceptorship and practice fields for training.
Assuntos
Humanos , Preceptoria , Atenção Primária à Saúde , Controle Social Formal , Sistema Único de Saúde , Estratégias de Saúde Nacionais , Recursos Humanos , Política de Saúde , Internato e Residência/tendências , BrasilRESUMO
A Atenção Básica vem ampliando sua cobertura populacional de forma acelerada desde sua implantação no Brasil, na década de 1990. Em 20 anos, a Estratégia de Saúde da Família estendeu sua cobertura de 5% para 60%, mas a capacidade de formação de médicos para ocupar tais posições não se desenvolveu na mesma velocidade, assim como não se desenvolveram tecnologias suficientes para o planejamento adequado de recursos humanos em saúde. Neste contexto é lançado o Programa Mais Médicos em julho de 2013 com ênfase na vinda de milhares de médicos estrangeiros para atuar na Atenção Básica, causando grande reação negativa das entidades médicas com inúmeras disputas ideológicas e judiciais. Este trabalho se propõe a lançar um olhar sobre os elementos de tensão entre Entidades Médicas e Governo no processo de implantação do Programa Mais Médicos e estudar o processo de evolução da regulação da formação de especialistas no país, na modalidade Residência Médica. Para tanto, optou-se por uma abordagem qualitativa no formato de estudo exploratório, utilizando-se de pesquisa bibliográfica e documental, assim como uma abordagem quantitativa na análise dos números de vagas de residência médica no país, com análise estatística descritiva dos dados. Os resultados apontam para melhora na capacidade de regulação de vagas para formação de especialistas no Brasil nos últimos cinco anos, sobretudo com o advento do PRÓ-RESIDÊNCIA e outras políticas de incentivo de abertura de vagas. A Lei nº12.871/2013 também aponta para importante evolução nas ferramentas de gestão de recursos humanos em saúde, além de mudanças e maior rigor na aplicação das Diretrizes Curriculares Nacionais para formação de médicos no país, com importante ênfase na Atenção Básica. Os resultados...
The population coverage of Primary Care has increased rapidly since its implementation in Brazil in the 1990s. Over 20 years, the Family Health Strategy extended its coverage from 5% to 60%, but the ability to train doctors to occupy such positions did not develop at the same rate, and sufficient technology for the proper planning of human resources for health has not evolved. In this context, the Mais Médicos Program was launched in July 2013 with emphasis on the coming of thousands of foreign doctors to work in Primary Care, causing an overwhelmingly negative reaction by medical organisations with numerous ideological and legal disputes. This paper aims to cast an eye on the elements of tension between Medical Entities and Government in the implementation process of the Mais Médicos Program and to study the process of development of the regulations of training specialists in the country, in Medical Residency. Therefore, we chose a qualitative approach in the exploratory format of the research, using bibliographic and documentary research, as well as a quantitative approach in the analysis of the numbers of medical residency positions in the country, with descriptive statistical analysis. The results indicate improvement in the capacity to regulate positions for training specialists in Brazil in the last five years, particularly with the advent of PRO-RESIDÊNCIA and other vacancy incentive policies. Law no. 12.871/2013 also points to important developments in human resource management tools in health, as well as changes and stricter application of the National Curriculum Guidelines for training doctors in the country, with major emphasis on Primary Care. The results also suggest a lack of understanding, on the part of doctors, regarding the Mais Médicos Program in its entirety, not only in the immediate ...
Assuntos
Humanos , Desenvolvimento de Programas/normas , Médicos de Atenção Primária/normas , Programação de Serviços de Saúde/métodos , Capacitação de Recursos Humanos em Saúde , Internato e Residência/métodosRESUMO
OBJECTIVE: To evaluate the long-term response and safety of interleukin-1 receptor antagonist (anakinra) in recurrent pericarditis. STUDY DESIGN: Fifteen patients (12 children, 3 adults) were enrolled in a multicenter retrospective study. All the patients were corticosteroid-dependent and 14 had received colchicine. Anakinra was given at 1-2 mg/kg/d. The primary outcome of the study was a reduction of at least 70% of disease flares after anakinra treatment compared with the pretreatment period. Secondary outcomes were: (1) number of complete or partial responders to anakinra and time for complete response; (2) number of patients who discontinued other ongoing treatments (non-steroidal anti-inflammatory drugs, corticosteroid, colchicine) and time needed for discontinuation; (3) number of relapses during continuous anakinra treatment; and (4) number of relapses during anakinra tapering or discontinuation. RESULTS: All patients treated had a complete response within a few days and were able to rapidly withdraw concomitant treatments, including corticosteroids. During daily treatment, no patient had a relapse of the disease; 14 patients started tapering and 6 of them experienced a relapse, with a prompt response after anakinra reintroduction. Overall, after a median follow-up of 39 months (range 6-57), a 95% reduction of flares was observed compared with pretreatment period. CONCLUSION: The long-term use of anakinra in monotherapy is associated with persistent control of recurrent pericarditis.