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Rodríguez-Feria P, Paric M, Flórez LJH, Babich S, Czabanowska K. Critical route for development of medical student leadership competencies in 35 Pan American Health Organization member states: A scoping review and thematic analysis. Int J Health Plann Manage 2024; 39:844-859. [PMID: 38439138 DOI: 10.1002/hpm.3791] [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: 09/27/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 03/06/2024] Open
Abstract
The Pan American Health Organization has been committed to training physicians in leadership competencies since 2008. However, four reviews on teaching leadership using competency-based education in undergraduate medical education (UME) identified only two of 35 MS: Canada and the USA. Previous reviews did not use a systemic approach or qualitative methodology to explore factors influencing leadership education. Therefore, this review aims to identify facilitating and inhibiting factors in teaching leadership in UME using a scoping review and thematic analysis. Six databases containing grey and indexed literature in English, Spanish, and Portuguese were searched, including a hand search and authors' consultations. Forty-eight documents out of 7849 were selected based on eligibility criteria. Braun and Clarke's thematic analysis guide was used, identifying eight themes: curriculum, intended learning outcomes, teaching methods, assessment, addressing barriers, supporting organisational change, building networks, and developing expertise. Considering these themes, the authors propose a critical route for teaching leadership in UME in the Americas. First, institutional design should consider governance gaps, such as having national and international policies for leadership training in UME with inter-professional, trans-professional, and citizen-focused approaches. There is a pressing need to provide leadership training for physicians and other professionals from government, academia, non-governmental organisations, hospitals, and national and international organisations whose missions are related to health or education. Networking opportunities for stakeholders in leadership education and teacher training is also essential. Second, instructional design reveals knowledge-do gaps in member states (MS) when incorporating leadership into the medical curriculum. This includes using leadership frameworks, defining learning outcomes, and employing assessment and monitoring tools for leadership education. Mechanisms to reduce these gaps in MS include the Equator Network and Evidence-Informed Policy Networks fostering knowledge translation and governance.
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Affiliation(s)
- Pablo Rodríguez-Feria
- Faculty of Health, Medicine and Life Sciences, Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Facultad de Medicina, Departamento de Salud Pública, Universidad de los Andes, Bogota, Colombia
| | - Martina Paric
- Faculty of Health, Medicine and Life Sciences, Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Luis Jorge Hernández Flórez
- Facultad de Medicina, Departamento de Salud Pública, Universidad de los Andes, Bogota, Colombia
- Program in Public Health, Schools of Medicine and Government, Universidad de Los Andes, Bogota, Colombia
| | - Suzanne Babich
- Faculty of Health, Medicine and Life Sciences, Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Community and Global Health, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Katarzyna Czabanowska
- Faculty of Health, Medicine and Life Sciences, Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Faculty of Health Sciences, Department of Health Policy and Management, Institute of Public Health, Jagiellonian University, Krakow, Poland
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Oberlohr V, Giordano V, Hungria JOS, Caiero M, Pires RE, da Silva LHP, Pallottino A, Sanchez GT, Labronici PJ, MacKechnie M, Miclau T. LEADERSHIP DEVELOPMENT TRAINING FOR BRAZILIAN ORTHOPEDIC SURGEONS. ACTA ORTOPEDICA BRASILEIRA 2024; 32:e272375. [PMID: 38532865 PMCID: PMC10962097 DOI: 10.1590/1413-785220243201e272375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 03/30/2023] [Indexed: 03/28/2024]
Abstract
Objective To report on the experience and impressions of the Brazilian orthopedic trauma surgeons attending the Leadership Development Program (LDP) hosted by the Sociedade Brasileira do Trauma Ortopédico (SBTO) in Sao Paulo, Brazil on November 4, 2022. Methods Forty-eight orthopedic trauma surgeons from five different regions throughout Brazil were provided a link to complete The Big Five Test, a validated online personality assessment. The questionnaire was available in Portuguese and was intended to provide a background on individual personality traits and their influence on interpersonal interactions. The LDP integrated content from literature reviews specific to Latin America, established leadership programs from leading business schools, and various subject matter experts. Prior to the start of the LDP, participants received a pre-course survey evaluating demographic information, a needs assessment, and the prioritization of leadership topics utilizing a 5-point Likert-scale. Attendees participated in the one-day, interactive LDP focusing on the fundamental principles of leadership development, communication, personal development, emotional intelligence and negotiation. Following the LDP, a post-course evaluation was administered to determine the participants' overall experience, and suggestions for LDP improvement. Results Forty-one of the forty-eight course participants completed the pre-course evaluation, whereas forty-six of the forty-eight participants completed the post-course evaluations. Overwhelmingly, the lack of opportunity was most prevalently reported as the main obstacle to attending a leadership course, as cited by 56% of respondents. Conclusion Expanding the accessibility, diversity, and customizability of leadership programs can facilitate the development of personal tools needed to move healthcare forward. Critical topics include emotional intelligence and other differentiating leadership qualities that distinguish true transformational and servant leaders. Advancing leadership skills can stimulate networking, expose learners to experiential learning styles, inspire others to create positive change, and engender creative solutions for systematic improvements and health outcomes. Level of Evidence III; Individual Case-Control Studies.
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Affiliation(s)
- Verena Oberlohr
- University of California, Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, San Francisco, School of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Vincenzo Giordano
- Hospital Municipal Miguel Couto, Prof. Nova Monteiro Orthopedics and Traumatology Department, Rio de Janeiro, RJ, Brazil
- Rede D’or São Luiz, Clínica São Vicente, Rio de Janeiro, RJ, Brazil
| | | | - Marcelo Caiero
- Hospital das Clínicas da Faculdade de Medicina da USP, Institute of Orthopedics and Traumatology, São Paulo, SP, Brazil
| | - Robinson Esteves Pires
- Universidade Federal de Minas Gerais (UFMG), Department of the Locomotor System, Belo Horizonte, MG, Brazil
| | | | - Alexandre Pallottino
- Hospital Central Aristarcho Pessoa - CBMERJ, Orthopedics Department, Rio de Janeiro, RJ, Brazil
| | - Gustavo Tadeu Sanchez
- UNIFESP (Universidade Federal de São Paulo), Paulista School of Medicine, Department of Orthopedics and Traumatology, São Paulo, SP, Brazil
| | - Pedro José Labronici
- Hospital Santa Teresa, Prof. Donato D’Ângelo Orthopedics and Traumatology Department, Petrópolis, Rio de Janeiro, RJ, Brazil
| | - Madeline MacKechnie
- University of California, Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, San Francisco, School of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Theodore Miclau
- University of California, Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, San Francisco, School of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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Rodríguez-Feria P, Czabanowska K, Babich S, Rodríguez-Sánchez D, Carreño Hernández FL, Hernández Flórez LJ. Divergence and Convergence of the Public Health Leadership Competency Framework Against Others in Undergraduate Medical Education: A Scoping Review. Public Health Rev 2023; 44:1605806. [PMID: 37426906 PMCID: PMC10323138 DOI: 10.3389/phrs.2023.1605806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/25/2023] [Indexed: 07/11/2023] Open
Abstract
Objective: The following scoping review is aimed at identifying leadership competency frameworks in Undergraduate Medical Education (UME) by analyzing the thematic scopes, target audiences, and methods involved. A further objective is to compare the frameworks against a standard framework. Methods: The authors extracted the thematic scope and methods of each framework based on the original author's formulations in each selected paper. The target audience was divided into three sections: UME, medical education, and beyond medical education. The frameworks were converged and diverged against the public health leadership competency framework. Results: Thirty-three frameworks covering thematic scopes such as refugees and migrants were identified. The most common methods to develop leadership frameworks were reviews and interviews. The courses targeted multiple disciplines including medicine and nurses. The identified competency frameworks have not converged among important domains of leadership such as systems thinking, political leadership, leading change, and emotional intelligence. Conclusion: There is a variety of frameworks that support leadership in UME. Nevertheless, they are not consistent in vital domains to face worldwide health challenges. Interdisciplinary and transdisciplinary leadership competency frameworks which address health challenges should be used in UME.
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Affiliation(s)
- Pablo Rodríguez-Feria
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Departamento de Salud Pública, Facultad de Medicina, Universidad de los Andes, Bogota, Colombia
| | - Katarzyna Czabanowska
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Department of Health Policy and Management, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University, Krakow, Poland
| | - Suzanne Babich
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indianapolis, IN, United States
| | | | | | - Luis Jorge Hernández Flórez
- Departamento de Salud Pública, Facultad de Medicina, Universidad de los Andes, Bogota, Colombia
- Program in Public Health, Schools of Medicine and Government, Universidad de Los Andes, Bogota, Colombia
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Armani-Franceschi G, Luz C, Lucena PH, d'Afonseca D, Sales H, Carvalho AL, Siqueira IC, Silva K, Portuense S, Monteiro L, Bandeira ID, Melo A, Lucena R. Botulinum Toxin Type A in the Spasticity of Cerebral Palsy Related to Congenital Zika Syndrome: An Observational Study. Dev Neurorehabil 2022; 25:162-169. [PMID: 34387523 DOI: 10.1080/17518423.2021.1960917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Investigate the effect of botulinum toxin type-A (BoNT-A) on spasticity and motor performance in children with Cerebral Palsy (CP) related to Congenital Zika Syndrome (CZS). METHODS Prospective longitudinal observational study of 34 children with CP referred for BoNT-A treatment. Outcomes were evaluated with a muscle tone assessment scale (Modified Ashworth Scale - MAS) and the Patients' Global Impression of Improvement (PGI-I) scale. RESULTS Mean age was 32.06 ± 3.07 months and 85% were classified as Gross Motor Function Classification System (GMFCS) V. Primitive reflexes were present in 56% of the sample. The majority of the parents (97.9%) reported improvement in range of motion or reduction in spasticity after treatment with botulinum toxin. No side effects were recorded. When compared to the baseline, median reduction in the MAS was 0.5 (IQR = 0). CONCLUSIONS The findings of this study suggest that BoNT-A may effectively promote functional improvements and reduce muscle tone, improving the child's and family's quality of life.
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Affiliation(s)
| | - Cleber Luz
- Universidade Federal da Bahia, Salvador, Brazil
| | - Pedro H Lucena
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | | | | | | | | | | | | | | | | | - Ailton Melo
- Universidade Federal da Bahia, Salvador, Brazil
| | - Rita Lucena
- Universidade Federal da Bahia, Salvador, Brazil
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Analysis of the superior temporal gyrus as a possible biomarker in schizophrenia using voxel-based morphometry of the brain magnetic resonance imaging: a comprehensive review. CNS Spectr 2021; 26:319-325. [PMID: 31918770 DOI: 10.1017/s1092852919001810] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The lack of predictive biomarkers for therapeutic responses to schizophrenia leads clinical procedures to be decided without taking into account the subjects' neuroanatomical features, a consideration, which could help in identifying specific pharmacological treatments for the remission of symptoms. Magnetic resonance imaging (MRI) is a technique widely used for radiological diagnosis and produces 3-dimensional images in excellent anatomical detail, and with a great capacity to differentiate soft tissue. Various MRI techniques of the human brain have emerged as a result of research, enabling structural tests that may help to in consolidate previous findings and lead to the discovery of new patterns of abnormality in schizophrenia. A literature review was undertaken to assess the superior temporal gyrus (STG) as a possible biomarker in schizophrenia with the use of voxel-based morphometry of the brain using MRI. Many findings in studies of schizophrenia using MRI have been inconclusive and, in some cases, conflicting, although interesting results have been obtained when attempting to correlate neuroimaging changes with aspects of clinical features and prognosis of the disease. The individuals affected by this mental illness appear to have smaller STG volumes when compared to healthy controls and also to subjects with a diagnosis of first-episode affective psychosis or groups of individuals at high risk of psychosis. However, the wide variety of definitions surrounding the STG found in a number of studies is a contributing factor to the lack of correlation between brain abnormalities and clinical symptoms. For instance, disagreements have arisen due to studies using regions of interest to analyze the STG whereas other studies prioritize the analysis of only STG subregions or specific supratemporal plane regions. It is necessary to standardize the nomenclature of the areas to be studied in the future, as this will enable more consistent results, allowing higher clinical and morphological correlations.
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Bandeira ID, Lins-Silva DH, Barouh JL, Faria-Guimarães D, Dorea-Bandeira I, Souza LS, Alves GS, Brunoni AR, Nitsche M, Fregni F, Lucena R. Neuroplasticity and non-invasive brain stimulation in the developing brain. PROGRESS IN BRAIN RESEARCH 2021; 264:57-89. [PMID: 34167665 DOI: 10.1016/bs.pbr.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The brain is a dynamic organ whose growth and organization varies according to each subject's life experiences. Through adaptations in gene expression and the release of neurotrophins and neurotransmitters, these experiences induce a process of cellular realignment and neural network reorganization, which consolidate what is called neuroplasticity. However, despite the brain's resilience and dynamism, neuroplasticity is maximized during the first years of life, when the developing brain is more sensitive to structural reorganization and the repair of damaged neurons. This review presents an overview of non-invasive brain stimulation (NIBS) techniques that have increasingly been a focus for experimental research and the development of therapeutic methods involving neuroplasticity, especially Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS). Due to its safety risk profile and extensive tolerability, several trials have demonstrated the benefits of NIBS as a feasible experimental alternative for the treatment of brain and mind disorders in children and adolescents. However, little is known about the late impact of neuroplasticity-inducing tools on the developing brain, and there are concerns about aberrant plasticity. There are also ethical considerations when performing interventions in the pediatric population. This article will therefore review these aspects and also obstacles related to the premature application of NIBS, given the limited evidence available concerning the extent to which these methods interfere with the developing brain.
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Affiliation(s)
- Igor D Bandeira
- Laboratory of Neuropsychopharmacology, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil; Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil.
| | - Daniel H Lins-Silva
- Laboratory of Neuropsychopharmacology, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil; Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Judah L Barouh
- Laboratory of Neuropsychopharmacology, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil; Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Daniela Faria-Guimarães
- Laboratory of Neuropsychopharmacology, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil; Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Ingrid Dorea-Bandeira
- Laboratory of Neuropsychopharmacology, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Lucca S Souza
- Laboratory of Neuropsychopharmacology, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil; Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Gustavo S Alves
- Laboratory of Neuropsychopharmacology, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil; Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation, Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Michael Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Center for Working Environment and Human Factors, Dortmund, Germany; Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard University, Charlestown, MA, United States
| | - Rita Lucena
- Department of Neuroscience and Mental Health, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
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Guimarães RSQ, Bandeira ID, Barretto BL, Barretto TL, Wanke T, Alves COC, de Carvalho CF, Lucena PH, Rodrigues-Silva L, Lucena R. The effects of transcranial direct current stimulation on attention and inhibitory control of children and adolescents with attention-deficit/hyperactivity disorder (ADHD): Study protocol for a randomized, sham-controlled, triple-blind, cross-over trial. Medicine (Baltimore) 2021; 100:e24283. [PMID: 33663047 PMCID: PMC7909171 DOI: 10.1097/md.0000000000024283] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Attention-deficit/hyperactivity disorder (ADHD) is characterized by a persistent pattern of inattention and hyperactivity/impulsivity. Despite the proven efficacy of pharmacological treatment, many individuals continue to suffer socially and academically and some experience significant side effects that negate the use psychotropic drugs. Transcranial direct current stimulation (tDCS) is a cortical neuromodulation feature that has shown positive results in the treatment of various neuropsychiatric conditions. OBJECTIVES To investigate the effect of tDCS on the performance of children and adolescents with ADHD in the neuropsychological tests of visual attention, verbal, and inhibitory control. METHODOLOGY Triple blind, randomized, sham-controlled, cross-over trial involving tDCS in children and adolescents with ADHD. Initial screening will be performed using Swanson, Nolan, and Pelham - IVand Wechsler intelligence scale for children fourth edition vocabulary and cube subtests. Individuals will be evaluated pre-tDCS and post-tDCS with the Wechsler intelligence scale for children fourth edition Digitus subtest, neuropsychological assessment battery second edition inhibiting responses subtest, Corsi cubes, and visual attention test-4.
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Affiliation(s)
| | - Igor D. Bandeira
- Postgraduate Program in Medicine and Health, Medical School of Bahia
- Laboratory of Neuropsychopharmacology, Psychiatry Division of the Professor Edgard Santos University Hospital
| | | | | | - Thamires Wanke
- Institute of Psychology, Federal University of Bahia, Salvador
| | | | | | | | | | - Rita Lucena
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
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Silva-Moraes MH, Bispo-Torres AC, Barouh JL, Lucena PH, Armani-Franceschi G, Dorea-Bandeira I, Vieira F, Miranda-Scippa Â, Quarantini LC, Lucena R, Bandeira ID. Suicidal behavior in individuals with amyotrophic lateral sclerosis: A systematic review. J Affect Disord 2020; 277:688-696. [PMID: 32911219 DOI: 10.1016/j.jad.2020.08.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/01/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Amyotrophic Lateral Sclerosis (ALS) leads to a drastic reduction in quality of life, generating intense psychological distress and predisposing those affected to mental illness and, in more severe cases, suicidal behavior. OBJECTIVE This is a systematic review aiming to estimate the frequency of wish to die, suicide ideation and suicide in individuals with ALS using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). METHODS The following databases were used: Pubmed/MEDLINE, PsycINFO, Embase, SciELO, Biblioteca Virtual de Saúde (BVS), and Cochrane Library. The choice of appropriate descriptors, or their equivalents, to define the search terms was based on the technical and scientific vocabulary of each database. RESULTS 13 articles were included in the present systematic review, of which three were cross-sectional studies, nine were cohort-type and there was one case-control study. The studies show that individuals with ALS have a higher risk of suicide in relation to the general population, and there is evidence that this risk is even higher in the early stages of the disease. Major Depressive Disorder was the most prevalent mental disorder in the studies included. This mental health concern is often undertreated, leading to the increased susceptibility of this population to suicide. LIMITATIONS In general, the study samples represent a highly heterogeneous population while many instruments used in the data collection were not uniform. CONCLUSIONS The high degree of psychological vulnerability of this population, associated with a greater predisposition to suicidal behavior, should be minimized through public health measures.
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Affiliation(s)
| | | | - Judah L Barouh
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil; Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Harvard University, Boston, United States
| | - Pedro H Lucena
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | | | - Ingrid Dorea-Bandeira
- Faculdade de Tecnologia e Ciências, Salvador, Brazil; Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Flavia Vieira
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil; Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Praça XV de Novembro, s/n - Largo do Terreiro de Jesus, Salvador, Bahia, Brazil
| | - Ângela Miranda-Scippa
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Lucas C Quarantini
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil; Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Rita Lucena
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Igor D Bandeira
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil; Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Praça XV de Novembro, s/n - Largo do Terreiro de Jesus, Salvador, Bahia, Brazil.
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Sales HF, Cerqueira C, Vaz D, Medeiros-Rios D, Armani-Franceschi G, Lucena PH, Sternberg C, Nóbrega AC, Luz C, Fonseca D, Carvalho AL, Monteiro L, Siqueira IC, Bandeira ID, Lucena R. The impact of botulinum toxin type A in the treatment of drooling in children with cerebral palsy secondary to Congenital Zika Syndrome: an observational study. Neurol Res 2020; 43:54-60. [PMID: 32915712 DOI: 10.1080/01616412.2020.1820698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The main aim of this study was to determine the impact of botulinum toxin A (BTX-A) on severity and frequency of drooling in children with Cerebral Palsy (CP) secondary to Congenital Zika Syndrome (CZS). METHODS This is a prospective longitudinal observational study including 23 children who received bilateral injections of BTX in the parotid and submandibular glands. The Thomas-Stonell & Greenberg Drooling Severity and Frequency Scale was applied by a multidisciplinary team including Speech, Language and Hearing professionals. The Global Impression of Improvement (GII) Scale was also applied to assess parents' subjective perceptions of therapeutic response. Swallowing was assessed using Doppler ultrasonography. Univariate logistic regression was used to analyse differences between responders and non-responders. RESULTS Participant age varied from 27 to 38 months (mean 31.78, SD = 2.61) all presented with Gross Motor Function Classification System (GMFCS) V. Drooling Severity and Frequency Scale scores ranged from 7 to 9 points (median = 9) prior to BTX administration and from 4 to 6 (median = 6) after. Pre- and post-treatment reduction in drooling severity occurred (Z = -3.746; p < 0.001). No cases of drooling worsening were reported. Only two subjects presented adverse effects attributed to BTX administration. Correlation was only confirmed with GII. DISCUSSION This article presents the safe and positive impact of BTX-A administration guided by anatomical references described in the literature, even on children with microcephaly. Further studies are needed to facilitate the use of Doppler ultrasonography as a tool to characterize changes in sensory processing and motor response following intraoral input in children with CP.
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Affiliation(s)
- Henrique F Sales
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia , Salvador, Brazil
| | - Caroline Cerqueira
- Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia , Salvador, Brazil
| | - Daniel Vaz
- Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia , Salvador, Brazil
| | - Débora Medeiros-Rios
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia , Salvador, Brazil
| | | | - Pedro H Lucena
- Escola Bahiana de Medicina e Saúde Pública , Salvador, Brazil
| | - Carla Sternberg
- Instituto de Ciências da Saúde, Universidade Federal da Bahia , Salvador, Brazil
| | - Ana C Nóbrega
- Instituto de Ciências da Saúde, Universidade Federal da Bahia , Salvador, Brazil
| | - Cleber Luz
- Instituto de Ciências da Saúde, Universidade Federal da Bahia , Salvador, Brazil
| | - Danilo Fonseca
- Instituto de Ciências da Saúde, Universidade Federal da Bahia , Salvador, Brazil
| | - Alessandra L Carvalho
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia , Salvador, Brazil
| | - Larissa Monteiro
- Departamento de Pediatria, Faculdade de Medicina da Bahia, Universidade Federal da Bahia , Salvador, Brazil
| | | | - Igor D Bandeira
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia , Salvador, Brazil.,Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia , Salvador, Brazil
| | - Rita Lucena
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia , Salvador, Brazil
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Conz CA, Jesus MCPD, Kortchmar E, Braga VAS, Machado RET, Merighi MAB. Path taken by morbidly obese people in search of bariatric surgery in the public health system. Rev Lat Am Enfermagem 2020; 28:e3294. [PMID: 32696927 PMCID: PMC7365606 DOI: 10.1590/1518-8345.3579.3294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/12/2020] [Indexed: 11/21/2022] Open
Abstract
Objective: to understand the path taken in the public health system by people with
morbid obesity in the search for bariatric surgery. Method: qualitative research based on the social phenomenology of Alfred Schütz, with
17 hospitalized morbidly obese people, with a scheduled date for bariatric
surgery. The phenomenological interview with open questions was used and the
statements were analyzed in the light of the theoretical-methodological
framework and literature related to the theme. Results: the participants were able to schedule bariatric surgery by referring
friends, family and public people. The waiting list for the procedure
generated anguish and anxiety due to fear of surgery, weight gain, risk of
worsening health and physical limitations, but it helped prepare for its
performance. The experience lived in the search for bariatric surgery led
these people to want continuity of care in the Basic Health Unit, after the
surgery, by professionals trained to meet their needs. Conclusion: the aspects inscribed in the path of people in search of bariatric surgery
signal the need to strengthen the assistance-related flows of the public
health system and to invest in professional training to reduce the social
inequalities in access to bariatric surgery and increased quality of
services.
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Affiliation(s)
| | | | - Estela Kortchmar
- Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
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Correia-Melo FS, Leal GC, Vieira F, Jesus-Nunes AP, Mello RP, Magnavita G, Caliman-Fontes AT, Echegaray MVF, Bandeira ID, Silva SS, Cavalcanti DE, Araújo-de-Freitas L, Sarin LM, Tuena MA, Nakahira C, Sampaio AS, Del-Porto JA, Turecki G, Loo C, Lacerda ALT, Quarantini LC. Efficacy and safety of adjunctive therapy using esketamine or racemic ketamine for adult treatment-resistant depression: A randomized, double-blind, non-inferiority study. J Affect Disord 2020; 264:527-534. [PMID: 31786030 DOI: 10.1016/j.jad.2019.11.086] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/08/2019] [Accepted: 11/12/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Ketamine and its enantiomers have recently been highlighted as one of the most effective therapeutic options in refractory depression. However, racemic ketamine and esketamine have not been directly compared. The aim of this study is to assess the efficacy and safety of esketamine compared to ketamine in patients with treatment-resistant depression (TRD). METHODS This is a randomized, double-blind, active-controlled, bicentre, non-inferiority clinical trial, with two parallel groups. Participants were randomly assigned to a 40-min single intravenous infusion of ketamine 0.5 mg/kg or esketamine 0.25 mg/kg. The primary outcome was the difference in remission rates for depression 24 h following intervention using the Montgomery-Åsberg Depression Rating Scale (MADRS), with a non-inferiority margin of 20%. RESULTS 63 subjects were included and randomly assigned (29 to receive ketamine and 34 to receive esketamine). At 24 h, 24.1% of participants in the ketamine group and 29.4% of participants in the esketamine group showed remission, with a difference of 5.3% (95% CILB -13.6%), confirming non-inferiority. MADRS scores improved from 33 (SD 9.3) to 16.2 (SD 10.7) in the ketamine group and from 33 (SD 5.3) to 17.5 (SD 12.2) in the esketamine one, with a difference of -5.27% (95% CILB, -13.6). Both groups presented similar mild side effects. CONCLUSIONS Esketamine was non-inferior to ketamine for TRD 24 h following infusion. Both treatments were effective, safe, and well tolerated. TRIAL REGISTRATION Registered in Japan Primary Registries Network: UMIN000032355.
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Affiliation(s)
- Fernanda S Correia-Melo
- Laboratory of Neuropsychopharmacology, Federal University of Bahia, Salvador, Brazil; Postgraduate Program in Medicine and Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil.
| | - Gustavo C Leal
- Laboratory of Neuropsychopharmacology, Federal University of Bahia, Salvador, Brazil; Postgraduate Program in Medicine and Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil; Division of Psychiatry, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil
| | - Flávia Vieira
- Laboratory of Neuropsychopharmacology, Federal University of Bahia, Salvador, Brazil; Postgraduate Program in Medicine and Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - Ana Paula Jesus-Nunes
- Laboratory of Neuropsychopharmacology, Federal University of Bahia, Salvador, Brazil; Postgraduate Program in Medicine and Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - Rodrigo P Mello
- Laboratory of Neuropsychopharmacology, Federal University of Bahia, Salvador, Brazil; Postgraduate Program in Medicine and Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - Guilherme Magnavita
- Laboratory of Neuropsychopharmacology, Federal University of Bahia, Salvador, Brazil
| | | | - Mariana V F Echegaray
- Laboratory of Neuropsychopharmacology, Federal University of Bahia, Salvador, Brazil
| | - Igor D Bandeira
- Laboratory of Neuropsychopharmacology, Federal University of Bahia, Salvador, Brazil; Postgraduate Program in Medicine and Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - Samantha S Silva
- Laboratory of Neuropsychopharmacology, Federal University of Bahia, Salvador, Brazil
| | - Diogo E Cavalcanti
- Division of Psychiatry, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil
| | - Lucas Araújo-de-Freitas
- Laboratory of Neuropsychopharmacology, Federal University of Bahia, Salvador, Brazil; Postgraduate Program in Medicine and Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - Luciana M Sarin
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Marco A Tuena
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Carolina Nakahira
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Aline S Sampaio
- Laboratory of Neuropsychopharmacology, Federal University of Bahia, Salvador, Brazil; Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - José A Del-Porto
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute & Department of Psychiatry, McGill University, Montreal, Canada
| | - Colleen Loo
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia; St George Hospital, South Eastern Sydney Health, Sydney, Australia
| | - Acioly L T Lacerda
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil; Interdisciplinary Laboratory of Clinical Neurosciences, Federal University of São Paulo, São Paulo, Brazil; Sinapse Institute of Clinical Neurosciences, Campinas, Brazil
| | - Lucas C Quarantini
- Laboratory of Neuropsychopharmacology, Federal University of Bahia, Salvador, Brazil; Postgraduate Program in Medicine and Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil; Division of Psychiatry, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil; Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
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Barreto TM, Bento MN, Barreto TM, Jagersbacher JG, Jones NS, Lucena R, Bandeira ID. Prevalence of depression, anxiety, and substance-related disorders in parents of children with cerebral palsy: a systematic review. Dev Med Child Neurol 2020; 62:163-168. [PMID: 31381150 DOI: 10.1111/dmcn.14321] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2019] [Indexed: 12/28/2022]
Abstract
AIM To estimate the prevalence of mental illness in parents of children with cerebral palsy (CP). METHOD This is a systematic review that follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols in the search for observational studies determining the prevalence of depression, anxiety, and substance abuse in parents of individuals with CP. The information sources used for this study were: PubMed, SciELO, Cochrane Library, Clinical Trials, and Biblioteca Virtual de Saúde. RESULTS Fourteen articles were selected and included, investigating 1264 mothers and 105 fathers of children with CP. Data extracted for analysis were divided into three categories: study data, data about participants with CP, and data about parents. All studies included volunteer parents, of whom 95 per cent were female. INTERPRETATION CP is related to a higher prevalence of symptoms of depression and anxiety in parents. Factors such as a child's degree of functionality and socioeconomic level may influence the frequency of mental disorders in parents. However, these studies have heterogeneous samples and applied different criteria to characterize their populations. WHAT THIS PAPER ADDS Depression and anxiety are more prevalent for parents of children with cerebral palsy (CP) than parents of typically developing children. The child's illness severity is a risk factor for mental illness in parents of children with CP. The more time spent on child care, the higher the risk of mental illness among mothers of children with CP. There is a lack of reliable data in the literature on substance abuse in parents of children with CP.
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Affiliation(s)
- Tainara M Barreto
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - Mayara N Bento
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - Tamiris M Barreto
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - João Gabriel Jagersbacher
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - Nathalia S Jones
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - Rita Lucena
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - Igor D Bandeira
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil.,Postgraduate Program in Medicine and Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
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