Contribuição à mudança curricular na graduação da Faculdade de Medicina de Botucatu

Descreve-se a inovação pedagógica de dois casos na graduação médica: uma matéria denominada Saúde Coletiva III, com (Administração, Ciências Sociais, Epidemiologia, Ética e Nutrição em Saúde Publica) e a disciplina de Semiologia Pediátrica. Para descrição e avaliação dos casos, utilizaram-se métodos qualitativos. A Saúde Coletiva III foi organizada por núcleos temáticos: Problemas em Saúde Publica; Nutrição em Saúde Publica; Planejamento em Saúde. O modelo de ensino centrou-se na problematização de situações vivenciadas na prática da Saúde Publica, trabalhando-se em centros, serviços e organizações de saúde. A Semiologia Pediátrica privilegiou a atenção integral à saúde da criança. O modelo de ensino centrou-se na aprendizagem baseada em problemas e no aprendizado prático da semiologia pediátrica em diferentes cenários, enfatizando-se o ensino ambulatorial. Privilegiou-se o trabalho em pequenos grupos, com a orientação docente. A principal missão voltou-se à utilização de estratégias que valorizassem o ensino centrado no estudante e sua capacidade de construir conhecimento com autonomia. No caso da Pediatria, avançou-se rumo a Medicina Integral, com enfoque amplo do modelo de atenção à criança. A Saúde Coletiva aproximou-se da Medicina Comunitária problematizando situações concretas no SUS e na atenção primária. O estudo mostra a possibilidade de inovação no ensino, e podendo contribuir para a mudança institucional.

Accuracy in dictation after improvement of reading and copying skills in a student with learning difficulties

The aim of this study was to use systematic teaching in a clinical setting using software to teach reading and writing in one boy with learning difficulties and obtain accurate performance in dictation. In the pre-test, the student showed good performance in matching-to-sample tasks (96% in matching printed words to dictated words; 88% in matching pictures to dictated words), although he obtained a low percentage of correct answers in the dictation of constructed responses (52%) and manuscripts (24%). The teaching strengthened the selection of printed words matched to dictated words and copying words. The student obtained 100% correct answers in the teaching tasks. In post-tests of dictation, he obtained 100% correct answers in constructed response and 96% correct answers in manuscripts. The results indicate that carefully teaching copying may promote accuracy in the performance of responding to minimal units in dictation tasks.

Gross Motor Deficits in Children Prenatally Exposed to Alcohol: A Meta-analysis

BACKGROUND AND OBJECTIVES: Gross motor (GM) deficits are often reported in children with prenatal alcohol exposure (PAE), but their prevalence and the domains affected are not clear. The objective of this review was to characterize GM impairment in children with a diagnosis of fetal alcohol spectrum disorder (FASD) or moderate to heavy maternal alcohol intake.METHODS: A systematic review with meta-analysis was conducted. Medline, Embase, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PEDro, and Google Scholar databases were searched. Published observational studies including children aged 0 to <= 18 years with (1) an FASD diagnosis or moderate to heavy PAE, or a mother with confirmed alcohol dependency or binge drinking during pregnancy, and (2) GM outcomes obtained by using a standardized assessment tool. Data were extracted regarding participants, exposure, diagnosis, and outcomes by using a standardized protocol. Methodological quality was evaluated by using Strengthening the Reporting of Observational Studies in Epidemiology guidelines.RESULTS: The search recovered 2881 articles of which 14 met the systematic review inclusion criteria. The subjects' mean age ranged from 3 days to 13 years. Study limitations included failure to report cutoffs for impairment, nonstandardized reporting of PAE, and small sample sizes. The meta-analysis pooled results (n = 10) revealed a significant association between a diagnosis of FASD or moderate to heavy PAE and GM impairment (odds ratio: 2.9; 95% confidence interval: 2.1-4.0). GM deficits were found in balance, coordination, and ball skills. There was insufficient data to determine prevalence.CONCLUSIONS: The significant results suggest evaluation of GM proficiency should be a standard component of multidisciplinary FASD diagnostic services.

Reliability of Web-Based Information in Inquiry Projects

This case study aims at identifying how a community of secondary school students selects web-based information and factors associated with the reliability of online reference sources during their collaborative inquiry (co-inquiry) projects. This study, conducted in a public secondary school in Brazil, focused on information literacy skills for collaborative open learning (colearning). The research is based on qualitative content analysis implemented on the online platform weSPOT. Although students are mindful of the importance of comparing different sources of information they seem not to be aware of reliability in online environments. Teacher's guidance is essential to support co-learners in developing competences, particularly related to critical thinking.

Greening of the essential activities of an Engineering School: a case study in the Area/Department of Production Engineering

This article analyzes the inclusion of the issue of “environmental management” in the department of Production Engineering of the “Alfa” School of Engineering. For this, a case study was conducted at the School of "Alpha" Engineering, with a focus on the area of Production Engineering. Professors were interviewed; documents were reviewed as well as information collected from direct observations by of one of the authors of this article. It was observed that the department of Production Engineering at the Alpha School of Engineering has been developing activities covering all those aspects proposed by Jabbour [8]. "Environmental management" has been included in the curriculums of: (a) Teaching: in the creation of undergraduate courses (obligatory) and graduate Master's degree (optional), (b) Research: formalization of research groups in environmental management for the creation of master’s post graduation research, formalization of environmental management as one of the subjects that should be chosen by candidates for a Professorship in the area of production engineering; (c) Extension: Course in Environmental Management, Symposium (which in recent years has been focusing on environmental issues), creation of sustainability indicators for universities, (d) University Management: initiatives to raise awareness, distribution of reusable mugs and installation of special bins for selective collection in the Campus.

Writing In Math Class? Written Communication in the Mathematics Classroom

In this action research study of my seventh grade mathematics classroom, I investigated what written communication within the mathematics classroom would look like. I increased vocabulary instruction of specific mathematical terms for my students to use in their writing. I also looked at what I would have to do differently in my teaching in order for my students to be successful in their writing. Although my students said that using writing to explain mathematics helped them to better understand the math, my research revealed that student writing did not necessarily translate to improved scores. After direct instruction and practice on math vocabulary, my students did use the vocabulary words more often in their writing; however, my students used the words more like they would in spelling sentences rather than to show what it meant and how it can be applied within their written explanation in math. In my teaching, I discovered I tried many different strategies to help my students be successful. I was very deliberate in my language and usage of vocabulary words and also in my explanations of various math concepts. As a result of this research, I plan to continue having my students use writing to communicate within the mathematics classroom. I will keep using some of the strategies I found successful. I also will be very deliberate in using vocabulary words and stress the use of vocabulary words with my students in the future.

On estimating the basic reproduction number in distinct stages of a contagious disease spreading

In epidemiology, the basic reproduction number R-0 is usually defined as the average number of new infections caused by a single infective individual introduced into a completely susceptible population. According to this definition. R-0 is related to the initial stage of the spreading of a contagious disease. However, from epidemiological models based on ordinary differential equations (ODE), R-0 is commonly derived from a linear stability analysis and interpreted as a bifurcation parameter: typically, when R-0 >1, the contagious disease tends to persist in the population because the endemic stationary solution is asymptotically stable: when R-0 <1, the corresponding pathogen tends to naturally disappear because the disease-free stationary solution is asymptotically stable. Here we intend to answer the following question: Do these two different approaches for calculating R-0 give the same numerical values? In other words, is the number of secondary infections caused by a unique sick individual equal to the threshold obtained from stability analysis of steady states of ODE? For finding the answer, we use a susceptibleinfective-recovered (SIR) model described in terms of ODE and also in terms of a probabilistic cellular automaton (PCA), where each individual (corresponding to a cell of the PCA lattice) is connected to others by a random network favoring local contacts. The values of R-0 obtained from both approaches are compared, showing good agreement. (C) 2012 Elsevier B.V. All rights reserved.

Position paper on the management of patients with obstructive sleep apnea and hypertension: joint recommendations by the European Society of Hypertension, by the European Respiratory Society and by the members of European COST (COoperation in Scientific and Technological research) ACTION B26 on obstructive sleep apnea

This article is aimed at addressing the current state of the art in epidemiology, pathophysiology, diagnostic procedures and treatment options for appropriate management of obstructive sleep apnea (OSA) in cardiovascular (particularly hypertensive) patients, as well as for the management of cardiovascular diseases (particularly arterial hypertension) in OSA patients. The present document is the result of the work done by a panel of experts participating in the European Union COST (COoperation in Scientific and Technological research) ACTION B26 on OSA, with the endorsement of the European Respiratory Society (ERS) and the European Society of Hypertension (ESH). These recommendations are particularly aimed at reminding cardiovascular experts to consider the occurrence of sleep-related breathing disorders in patients with high blood pressure. They are at the same time aimed at reminding respiration experts to consider the occurrence of hypertension in patients with respiratory problems at night.

Developing Higher-level Cognitive Skills In a Fire Protection Course

In an ideal world, all instructors of safety and health courses would be masters of course subject matter as well as the theories and practices for effective teaching. In practice, however, most instructors are much stronger in one or the other. This paper provides an example of how some fundamental knowledge from educational experts can be useful for improving a traditional safety course. Is there a problem with the way traditional safety and health (S&H) courses are taught? It is asserted by this author that S&H education, in general, places too much emphasis on acquisition and comprehension of facts at the expense of helping students develop higher-level cognitive abilities. This paper explains the basis for the assertion and reports an experience upgrading a traditional fire protection course to include more assignments involving the higher-level ability known in the education community as synthesis.

Strengthening the Reporting of Molecular Epidemiology for Infectious Diseases (STROME-ID): an extension of the STROBE statement

Molecular data are now widely used in epidemiological studies to investigate the transmission, distribution, biology, and diversity of pathogens. Our objective was to establish recommendations to support good scientific reporting of molecular epidemiological studies to encourage authors to consider specific threats to valid inference. The statement Strengthening the Reporting of Molecular Epidemiology for Infectious Diseases (STROME-ID) builds upon the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative. The STROME-ID statement was developed by a working group of epidemiologists, statisticians, bioinformaticians, virologists, and microbiologists with expertise in control of infection and communicable diseases. The statement focuses on issues relating to the reporting of epidemiological studies of infectious diseases using molecular data that were not addressed by STROBE. STROME-ID addresses terminology, measures of genetic diversity within pathogen populations, laboratory methods, sample collection, use of molecular markers, molecular clocks, timeframe, multiple-strain infections, non-independence of infectious-disease data, missing data, ascertainment bias, consistency between molecular and epidemiological data, and ethical considerations with respect to infectious-disease research. In total, 20 items were added to the 22 item STROBE checklist. When used, the STROME-ID recommendations should advance the quality and transparency of scientific reporting, with clear benefits for evidence reviews and health-policy decision making.

European undergraduate curriculum in geriatric medicine developed using an international modified Delphi technique.

INTRODUCTION the rise in the number of older, frail adults necessitates that future doctors are adequately trained in the skills of geriatric medicine. Few countries have dedicated curricula in geriatric medicine at the undergraduate level. The aim of this project was to develop a consensus among geriatricians on a curriculum with the minimal requirements that a medical student should achieve by the end of medical school. METHODS a modified Delphi process was used. First, educational experts and geriatricians proposed a set of learning objectives based on a literature review. Second, three Delphi rounds involving a panel with 49 experts representing 29 countries affiliated to the European Union of Medical Specialists (UEMS) was used to gain consensus for a final curriculum. RESULTS the number of disagreements following Delphi Rounds 1 and 2 were 81 and 53, respectively. Complete agreement was reached following the third round. The final curriculum consisted of detailed objectives grouped under 10 overarching learning outcomes. DISCUSSION a consensus on the minimum requirements of geriatric learning objectives for medical students has been agreed by European geriatricians. Major efforts will be needed to implement these requirements, given the large variation in the quality of geriatric teaching in medical schools. This curriculum is a first step to help improve teaching of geriatrics in medical schools, and will also serve as a basis for advancing postgraduate training in geriatrics across Europe.

Adiposity and cancer risk: new mechanistic insights from epidemiology

Excess body adiposity, commonly expressed as body mass index (BMI), is a risk factor for many common adult cancers. Over the past decade, epidemiological data have shown that adiposity-cancer risk associations are specific for gender, site, geographical population, histological subtype and molecular phenotype. The biological mechanisms underpinning these associations are incompletely understood but need to take account of the specificities observed in epidemiology to better inform future prevention strategies.

What supports students' education in the operating room? A focus group study including students' and surgeons' views.

BACKGROUND AND METHODS We conducted a focus group analysis with students and surgeons on factors which influence medical school students' education in the operating room (OR). The interviews were analyzed using grounded theory. RESULTS The analysis resulted in 18 detailed and easily applyable themes, which were grouped into the four categories: "Students' preparation and organizational aspects", "Learning objectives", "Educational strategies for the teacher", and "Social-environmental aspects". CONCLUSION By including students and surgeons, we were able to extend existing knowledge and enable better understanding of factors influencing teaching in the OR.

National competence center for wildlife diseases in Switzerland: Mandate, development and current strategies.

The need for wildlife health surveillance has become increasingly recognized. However, comprehensive programs which cover a wide spectrum of species, pathogens and geographic areas are still lacking in most European countries and practical examples of systems in place remain scarce. This article provides an overview of the organization of wildlife health surveillance in Switzerland, with a focus on the development, current strategies and the activities of the national program carried out by the Centre for Fish and Wildlife Health (FIWI), University of Bern. This documentation may stimulate on-going discussions on the design and development of national wildlife health surveillance programs in other countries. Investigations into wildlife health in Switzerland date back to the 1950s. The FIWI acts as a national competence center for wildlife diseases on mandate of the Swiss federal authorities. The mandate includes four main activities: disease diagnostics, research, consulting and teaching. In line with this, the FIWI has made continuous efforts to strengthen a national network of field partners and implemented strategies to facilitate long-term and metastudies.