Resumo: Introdução: A pandemia causada pelo novo coronavírus (Covid-19) promoveu mudanças em todo o mundo, gerando modificações na estrutura organizacional do ensino superior. A educação médica teve que suspender atividades presenciais e estágios práticos, e adotar a metodologia de ensino a distância e avaliações on-line para os discentes de Medicina. Objetivo: Discorrer sobre o impacto da pandemia na saúde mental dos universitários e na educação médica. Método: Trata-se de uma revisão de literatura realizada nas seguintes bases de dados: Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Medical Literature Analysis and Retrieval System Online (MEDLINE). Utilizaram-se, na busca de artigos, os Descritores em Ciências da Saúde (DeCS): “saúde mental”, “pandemia”, “educação superior”, “estudantes” e “Covid-19”. Foram considerados estudos com seres humanos e estudos de literatura publicados de 2018 até o momento do levantamento de dados. Resultado: Nas bases de dados, encontraram-se 1.473 artigos que foram submetidos aos critérios de inclusão e exclusão. Desconsiderando a duplicidade em outras bases de dados, obtiveram-se 43 artigos, dos quais 31 foram utilizados nesta revisão de literatura. Tem-se um grande número de estudos experimentais sobre a educação superior que são úteis na disseminação de conhecimento e possibilidade de replicação. Os dados referentes à saúde mental dos estudantes universitários abordam aspectos sobre a presença de transtornos psiquiátricos relacionados à temática, como depressão, ansiedade, e estresse pós-traumático, a partir de testes de triagem diagnóstica, nas variações presencial e on-line. Conclusão: Como os estudantes de Medicina apresentam incertezas sobre o futuro de sua formação em decorrência dessas transformações, são submetidos a uma carga emocional que causa/deflagra danos à saúde mental deles. Existem ainda dúvidas sobre os reflexos desse contexto no período “pós-Covid” e seus impactos na educação médica, assim como sobre a manutenção de medidas adotadas em tempos de crise.

Background Pulmonary rehabilitation (PR) has demonstrated patients’ physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit. Methods A 12-week community-based PR will be implemented in primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers (dyads patient-caregivers) will compose the experimental group. The control group will include dyads age- and disease-matched willing to collaborate in data collection but not in PR. Patients/family-centred outcomes will be dyspnoea (modified Medical Research Council Questionnaire), fatigue (Checklist of individual strength and Functional assessment of chronic illness therapy – fatigue), cough and sputum (Leicester cough questionnaire and Cough and sputum assessment questionnaire), impact of the disease (COPD Assessment Test), emotional state (The Hospital Anxiety and Depression Scale), number of exacerbations, healthcare utilisation, health-related quality of life and family adaptability/cohesion (Family Adaptation and Cohesion Scale). Other clinical outcomes will be peripheral (biceps and quadriceps-hand held dynamometer, 1 or 10 repetition-maximum) and respiratory (maximal inspiratory and expiratory pressures) muscle strength, muscle thickness and cross sectional area (biceps brachialis, rectus femoris and diaphragm-ultrasound imaging), exercise capacity (six-minute walk test and one-minute sit to stand test), balance (brief-balance evaluation systems test) and physical activity (accelerometer). Data will be collected at baseline, at 12 weeks, at 3- and 6-months post-PR. Changes in the outcome measures will be compared between groups, after multivariate adjustment for possible confounders, and effect sizes will be calculated. A cost-benefit analysis will be conducted. Discussion This study will enhance patients access to PR, by training healthcare professionals in the local primary healthcare centres to conduct such programmes and actively involving caregivers. The cost-benefit analysis of this intervention will provide an evidence-based insight into the economic benefit of community-based PR in chronic respiratory diseases. Trial registration The trial was registered in the ClinicalTrials.gov U.S. National Library of Medicine, on 10th January, 2019 (registration number: NCT03799666 ). Electronic supplementary material The online version of this article (10.1186/s12889-019-7045-1) contai...

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Reiki e meditação mindfullness no manejo do paciente com dores crônicas: uma revisão de literaturaReiki and mindfullness meditation in the management of patients with chronic pain: a literature review

Background: Pulmonary rehabilitation (PR) is a well-established and evidence-based intervention to manage chronic respiratory diseases (CRD), but its benefits diminish over time. Self-management can slow down this tendency and digital technologies may have a key-role in such approaches. However, few studies have evaluated the access to digital technology among patients with CRD, which is fundamental for the implementation of technology-based selfmanagement strategies. Aims: The objective of this study was to explore if patients with CRD have access to digital technology and if they feel confident in using it. Methods: This was an exploratory cross-sectional study. Patients with CRD were recruited from community-based PR programmes between October 2017 and September 2018. Patients were surveyed regarding access to computers, smartphones, tablets, cell phones and internet. Their confidence in using these technologies was assessed using a numerical scale from 0 (not at all confident) to 10 (completely confident). Patients were considered confident when a score higher than5 was selected. Chisquare tests were used to explore if access to digital technology was related to age, sex, marital status, education or occupation. Results: 123 patients (n=76; 62% male; 67±11 [32-87] years) were included. Chronic obstructive pulmonary disease (n=73; 59%) and asthma (n=23; 19%) were the most common diagnosis. 80% of patients reported having access to digital technology: 34% reported having a computer, 44% owned a smartphone or tablet and 36% a cell phone. 81% of patients reported themselves as confident in using these technologies (median 7, interquartile range 5-8.5). About half of them (n=64; 52%) used the internet and, from these, 84% felt confident in using it (median 8, interquartile range 5-9). Patients with access to digital technology and internet were younger (p=.029 and p<.001) and with higher levels of education (p=.010 and p<.001). No further associations were found. Conclusions: Patients with CRD have access to and feel confident in using digital technologies. These results reinforce the potential of using digital technologies as a resource for the implementation of selfmanagement strategies in this population.