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巴西初级卫生保健中的遗传学与国家罕见病患者综合护理政策:专业教育的机遇与挑战

Genetics in primary health care and the National Policy on Comprehensive Care for People with Rare Diseases in Brazil: opportunities and challenges for professional education.

作者信息

Melo Débora Gusmão, de Paula Pamela Karen, de Araujo Rodrigues Stephania, da Silva de Avó Lucimar Retto, Germano Carla Maria Ramos, Demarzo Marcelo Marcos Piva

机构信息

Department of Medicine, Federal University of São Carlos, Rod. Washington Luís (SP-310), Km 235, Campus da UFSCar, 13565-905, São Paulo, Brazil,

出版信息

J Community Genet. 2015 Jul;6(3):231-40. doi: 10.1007/s12687-015-0224-6. Epub 2015 Apr 18.

Abstract

As discoveries regarding the genetic contribution to disease have grown rapidly, health care professionals are expected to incorporate genetic and genomic perspectives into health education and practice. Genetic competencies common to all health professionals have been identified by the US National Coalition for Health Professional Education in Genetics (NCHPEG), which defined the knowledge, skills, and attitudes required to achieve these competencies. The aim of this study is to analyze genetic competencies of primary health care professionals in Brazil. It is a descriptive survey study, whereby doctors, nurses, and dentists were invited to participate by answering a questionnaire including 11 issues based on competencies established by the NCHPEG. Data were presented as percentages. Differences between groups of participants were assessed by the Fisher exact test, with the level of significance set at p < 0.05. Results showed that concerning knowledge, about 80 % of the participants recognized basic genetics terminology, but practitioners had difficulty in identifying patterns of inheritance. Regarding clinical skills, practitioners were able to recognize facial dysmorphias and identify situations where referral of patients to specialists was necessary. Nevertheless, there were challenges in the process of valuing and gathering information about family history. Regarding attitudes, 68.9 % of the participants thought about the comprehensiveness of care but faced challenges in counselling parents. The results of this study may contribute to developing an ongoing education program for primary health care professionals, leading to a strategy to overcome the challenges of including genetics in the Brazilian Unified Health System.

摘要

随着有关疾病遗传因素的发现迅速增加,医疗保健专业人员有望将遗传和基因组观点纳入健康教育与实践中。美国国家遗传专业人员健康教育联盟(NCHPEG)确定了所有医疗专业人员共有的遗传能力,该联盟明确了实现这些能力所需的知识、技能和态度。本研究的目的是分析巴西初级医疗保健专业人员的遗传能力。这是一项描述性调查研究,通过邀请医生、护士和牙医回答一份基于NCHPEG确定的能力的包含11个问题的问卷来参与。数据以百分比形式呈现。通过Fisher精确检验评估参与者组之间的差异,显著性水平设定为p < 0.05。结果显示,在知识方面,约80%的参与者认识基本的遗传学术语,但从业者在识别遗传模式方面存在困难。在临床技能方面,从业者能够识别面部畸形并确定将患者转诊给专科医生的必要情况。然而,在评估和收集家族史信息的过程中存在挑战。在态度方面,68.9%的参与者考虑到护理的全面性,但在为父母提供咨询时面临挑战。本研究结果可能有助于为初级医疗保健专业人员制定持续教育计划,从而形成一项克服在巴西统一卫生系统中纳入遗传学挑战的策略。

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