Revista da Associacao Medica Brasileira (1992)最新文献

Objective: The aim of this study was to analyze the provision of lato sensu postgraduate courses within the context of specialist medical training in Brazil.

Methods: Using a qualitative research approach, in-depth interviews were conducted based on a semi-structured guide with 24 key informants occupying strategic roles in the training of medical specialists. Participants included health system managers, medical educators, leaders of professional Medical Societies, and representatives from both public and private sectors.

Results: Four core themes emerged from the interviews regarding lato sensu postgraduate courses in medicine, reflecting key concerns and perceptions raised by participants: the lack of regulation and oversight amid an expanding market; risks to the quality of specialist medical training; the predominance of private-sector provision, often misaligned with the needs of Brazil's Unified Health System; and the importance of preserving the existing framework for specialist certification, as overseen by the National Commission for Medical Residency and the Brazilian Medical Association.

Conclusion: Lato sensu postgraduate courses may serve a complementary role in the continuing education of doctors, but they are not a substitute for Medical Residency or the Specialist title granted by the Brazilian Association or Society of the respective specialty, which is affiliated to the Brazilian Medical Association. These programs should be subject to formal regulation and oversight, whether implemented by governmental authorities or delegated to competent civil society organizations.

Objective: The aim of the study was to compare the surgical outcomes of vaginal natural orifice transluminal endoscopic surgery and conventional vaginal hysterectomy for benign gynecological conditions.

Methods: A prospective randomized controlled trial was conducted at a tertiary hospital from January 2025 to February 2025. Patients aged 40-80 who underwent hysterectomy for benign indications were included. Outcomes assessed included surgical outcomes, visual analog scale pain scores, and complication rates.

Results: A total of 144 patients were included, with 72 undergoing vaginal natural orifice transluminal endoscopic surgery and 72 undergoing vaginal hysterectomy. No significant differences were found in demographic characteristics, surgical duration (100.8±14.1 min for vaginal natural orifice transluminal endoscopic surgery vs. 99.3±26.7 min for vaginal hysterectomy, p=0.646), or complication rates. The vaginal natural orifice transluminal endoscopic surgery group had a higher rate of bilateral salpingo-oophorectomy (97.2 vs. 36.1%, p<0.001) and required fewer non-steroidal anti-inflammatory drugs postoperatively (median 2.0 vs. 3.0, p=0.003).

Conclusion: This study indicates that vaginal natural orifice transluminal endoscopic surgery is a feasible alternative to vaginal hysterectomy for benign hysterectomies, demonstrating comparable outcomes and potential benefits in postoperative pain management. Future multi-center studies are warranted to strengthen the evidence base and explore long-term outcomes.

Objective: The aim of this study was to examine the prevalence of burnout among pregnant working individuals and its effects on both obstetric complications and issues that may arise in the early postpartum period.

Methods: Healthy pregnant women were questioned regarding their working life and Maslach Burnout Inventory. They were divided into two groups-burnout and non-burnout-according to the burnout score. The two groups were compared in terms of pregnancy and postpartum complications and breastfeeding.

Results: Burnout was identified in 164 pregnant women (54.1%). The age of the women with burnout was statistically significantly higher than that of the group without burnout. The breastfeeding rate was lower in the burnout group. In the evaluation of postpartum infective complications, 19.5% of the women with burnout and 8.6% of those without burnout developed infections, and this difference was statistically significant.

Conclusion: It has been demonstrated that burnout increases the risk of infectious complications in pregnancy, reduces postpartum breastfeeding rates, and contributes to other negative outcomes.

Introduction: The aim of the study was to compare the effects of dry needling and kinesio taping on pain intensity, mandibular range of motion, sleep quality, and depression levels in patients diagnosed with myogenous temporomandibular dysfunction (TMD).

Methods: Ninety patients with TMD were included in this two-center randomized controlled trial. Participants were randomly assigned to three groups: Group A (dry needling), Group B (kinesio taping), and Group C (control-conservative recommendations). Interventions were applied over 6 weeks. Primary outcome measures included the visual analog scale, Beck Depression Inventory, Pittsburgh Sleep Quality Index, and mandibular mobility assessment.

Results: Both intervention groups demonstrated significant improvements in pain reduction, increased mandibular range of motion, and improved sleep quality (p<0.05). The dry needling group showed superior outcomes compared to the other groups. While both the dry needling and kinesio taping groups showed within-group improvements in depression scores, between-group differences were not statistically significant (p=0.464), and lateral mandibular movements did not differ significantly among groups.

Conclusion: Dry needling and kinesio taping are effective, safe, and clinically feasible interventions for the management of TMD. Dry needling, in particular, appears more effective in reducing pain and improving function. These findings highlight the importance of incorporating conservative physical therapy approaches within multidisciplinary TMD treatment protocols.

Objective: The aim of this study was to determine the anxiety, embarrassment, and pain levels of patients undergoing a cystoscopy procedure.

Methods: This cross-sectional study was conducted on 151 male patients who underwent cystoscopy in a hospital operating room between October 2021 and 2022. Data were collected with the Beck Anxiety Inventory for anxiety in preoperative; the Numeric Rating Scale for anxiety, embarrassment, and pain in intraoperative.

Results: The mean score of the patients' Beck Anxiety Inventory was 3.810±6.905; the mean scores of the first and second Numeric Rating Scale measurements were 1.79±1.23; 1.94±1.28 for anxiety; 2.77±2.54; 2.32±2.30 for embarrassment; 1.44±0.75; 3.46±2.15 for pain, respectively. As a result of the regression analysis, the anxiety levels of the patients before the procedure explained 15.2 and 38.6% of the embarrassment and pain levels during the procedure, respectively.

Conclusion: Anxiety, embarrassment, and pain levels of the patients in terms of the cystoscopy procedure were related to each other, and these parameters varied during different steps of the procedure.

Objective: The aim of the study was to determine the prevalence, socio-demographic, and health-related predictors of frailty among community-dwelling elderly Chinese with hypertension.

Methods: It's a cross-sectional survey design among 338 respondents; the Chinese version of the Tilburg Frailty Assessment Scale was used to screen elderly hypertensive adults for frailty. The socio-demographic data were collected using a self-developed questionnaire. Data collected were analyzed using binary logistic regressions at a of 95%CI.

Results: The result of the study shows that the prevalence of frailty among community-dwelling older adults with hypertension in Henan province was 32.5%. The result of the socio-demographic predictors was being a female (p=0.001, OR 3.669 [CI 1.967-6.843]) and living in a rural area (p=0.032, OR 3.487 [CI 1.116-10.898]). While the leading health predictors were found to be a comorbidity of three or more conditions (p=0.001, OR 57.233 [CI 21.883-149.689]); history of hypertension spanning longer than 11 years (p=0.001, OR 10.541 [CI 5.404-20.561]).

Conclusion: More attention should be focused on elderly hypertensive women to reduce the impact.

Objective: The aims of this study were to gain more comprehensive information about the preferences of midwives and nurses regarding cesarean childbirth and the reasons behind their decisions.

Methods: This study was made phenomenological research using a qualitative study with 16 midwives and nurses between 1 January and 30 December 2023, at a state hospital. Content analysis was performed on the data obtained from the interviews.

Results: The study led to the conclusions that midwives and nurses preferred the mode of cesarean delivery based on their doctor's advice, their desire to avoid taking any risks, and their fear of pain and complications that could arise in vaginal childbirth, but that they also encountered postoperative problems following the C-section procedure that included respiratory issues in the newborn, delays in lactation, and difficulties with breastfeeding. It was also found that the midwives and nurses were aware that they were in a position as health workers to influence women choosing a mode of delivery and that they could have a part in contributing to the rising cesarean rates.

Conclusion: On the basis of these conclusions, it might be recommended that midwives and nurses recognize that they are role models in the community and as health workers, they must consider current evidence-based data when deciding on a mode of childbirth, and ground their health application decisions on scientific knowledge.