Staphylococcus aureus: resistência de virulência e tipagem de MRSA pelas técnicas de MLST e spa typing

Pós-graduação em Doenças Tropicais - FMB

Social support and common mental disorder among medical students

INTRODUÇÃO:Diferentes formas de sofrimento psíquico têm sido identificadas em estudantes da área da saúde, em especial no curso de Medicina.OBJETIVO:Estimar a prevalência de sofrimento psíquico entre estudantes de Medicina em uma faculdade no Sudeste do Brasil e avaliar sua associação com apoio social.MÉTODO:Trata-se de um estudo transversal. Foram aplicados questionários para alunos do 1º ao 6º ano do curso de Medicina da Universidade Estadual Paulista Júlio de Mesquita Filho, investigando-se características demográficas relacionadas ao curso e à adaptação à cidade. Sofrimento psíquico foi investigado na forma de Transtorno Mental Comum (TMC), avaliado por meio do Self-Reporting Questionnaire (SRQ-20). Apoio social foi avaliado com a Escala de Apoio Social (EAS). As associações entre o desfecho e as variáveis explanatórias foram analisadas por meio do teste do χ2 e, na análise multivariada, por meio da Regressão Logística, com p < 0,05.RESULTADOS:A taxa de resposta foi de 80,7%, não havendo diferença estatística entre a mostra e a população-alvo no que diz respeito ao gênero (p = 0,78). A média de idade foi de 22 anos (desvio padrão - DP = 2,2) com predomínio de mulheres (58,2%) e estudantes que vivem com amigos (62%). A prevalência de TMC foi de 44,9% (IC95% 40,2 - 49,6). Após a análise multivariada, mantiveram-se associados a TMC: sentir-se rejeitado no último ano (p < 0,001), ter pensado ou pensar em abandonar o curso (p < 0,001) e interação, avaliada pela EAS (p = 0,002).CONCLUSÕES:A prevalência de TMC entre estudantes de Medicina mostrou-se elevada, identificando-se o apoio social insuficiente como fator de risco. Esses achados sugerem que intervenções voltadas para propiciar melhores condições de interação social entre estudantes poderiam ser benéficas, diminuindo a prevalência de TMC nesse grupo.

Testing search strategies for systematic reviews in the Medline literature database through PubMed

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Undergraduate research in medical education: a descriptive study of students' views

Background: Medical students engage in curricular and extracurricular activities, including undergraduate research (UR). The advantages, difficulties and motivations for medical students pursuing research activities during their studies have rarely been addressed. In Brazil, some medical schools have included undergraduate research into their curriculum. The present study aimed to understand the reality of scientific practice among medical students at a well-established Brazilian medical school, analyzing this context from the students' viewpoint.Methods: A cross-sectional survey based on a questionnaire applied to students from years one to six enrolled in an established Brazilian medical school that currently has no curricular UR program.Results: The questionnaire was answered by 415 students, 47.2% of whom were involved in research activities, with greater participation in UR in the second half of the course. Independent of student involvement in research activities, time constraints were cited as the main obstacle to participation. Among students not involved in UR, 91.1% said they favored its inclusion in the curriculum, since this would facilitate the development of such activity. This approach could signify an approximation between the axes of teaching and research. Among students who had completed at least one UR project, 87.7% said they would recommend the activity to students entering the course.Conclusion: Even without an undergraduate research program, students of this medical school report strong involvement in research activities, but discussion of the difficulties inherent in its practice is important to future developments.

Polimorfismo do gene IL6 candidato à predisposição à rotura prematura de membranas pré-termo e ao trabalho de parto pré-termo

Introduction: Preterm Labor (PTL) and Preterm Premature Rupture of Membranes (PPROM) cause severe complications for both mother and fetus. Among the risk factors associated with preterm labor and PPROM, genetic predisposition has been gaining importance. However, the association between polymorphic genes and the pathogenesis of PTL and PPROM remains elusive. A better understanding of the genetic mechanisms underlying these adverse pregnancy outcomes may enable the identification of high risk patients and allow new approaches to minimize the deleterious effects of prematurity. Aim: To determine the association between maternal IL-6 polymorphism gene and the occurrence of PTL and PPROM. Patients and Methods: The study included 109 patients with prior history of PL and/or PPROM that delivered prematurely at the Obstetrical Unit Care of Botucatu Medical School, UNESP between 2003 and 2012. The control group consisted of 68 patients that delivered at term, matched to the case group by age, ethnicity, and sex of the newborn. Oral swabs (Cath-AllTM – Epicentre Biotechnologies) were collected for analysis of genetic polymorphisms by PCR. Statistical tests were performed to compare genotype, clinical and socio-demographic data from the groups. A p-value of <0.05 was considered significant. Results: The sociodemographic characteristics in both groups were homogeneously distributed. The frequency of the polymorphic allele C, associated with less production of IL-6, and therefore thought to be protective against PTL and PPROM, was 32,5% in the study group and 30,9% in the control group, without statistically significant differences. Conclusion: Considering the sample size included in this study, the frequency of the mutated allele is similar in pregnant women who delivered at term and gestational complications as PTL and PPROM

Distribuição e dispersão dos níveis radiométricos do setor técnico de medicina nuclear do hospital das clínicas da faculdade de medicina de botucatu

Nuclear medicine uses non-sealed sources for exams and treatments, because the movement of these sources, source of patients injected or not, involve a wide range of environmental radiometric levels. To better control of these levels this study was aimed at monitoring points strategically distributed in all environments Sector Technical Nuclear Medicine, Hospital of the Botucatu Medical School, performing two measurements at random times daily for a period of three months, sampling the normal routine of the sector. The detector Geiger-Muller was used for the acquisition of exposure rates of the points, efficiency and reprodutibility test have shown good performance of this equipment for this purpose. The results allowed to make a projection of annual dose for each environment indicating higher risks for Occupationally Exposed Individuals as well as Public Individuals compared with the limits established by the National Commission of Nuclear Energy. Was developed a spatial map of dose that can be used as a visual warning to the regions with the highest exposure to ionizing radiation, enabling reduced risk of a potential exposure

Diagnósticos de Enfermagem Prevalentes de Pacientes em Pós-Operatório de Cirurgia Bariátrica em uma Unidade de Terapia Intensiva

The goal of this study is to characterize the clinical outline of patients in postoperative of bariatric surgery attended in an Intensive Care Unit and identify the nursing diagnosis presented by these patients in accordance to Taxonomy II of North American Nursing Diagnosis Association (NANDA). This is a transversal, descriptive and prospective study that was desenvolved at the Intensive Care Unit of the Clinical Hospital of Botucatu Medical School – UNESP. The population was composed by all the patients who were submitted to the bariatric surgery and were attended at the Intensive Care Unit in the period between June and August of 2010, totalizing 13 patients. The data were collected based on the Nursing History that is composed by the Anamnesis, Physical Examination and Complementary Exams. The results were worked out: a) among the 13 patients studied, 10 are women (76,9%) and 3 men (23,1%); the majority is between 30 and 40 years old; 11 people of 13 are morbid obese, which means that they have Body Mass Index higher than 40 kg/m2; b) It was identified 22 nursing diagnosis and 14 of these were found in 100% of the patients. They belong to the dominions of Activity/Rest, Comfort, Elimination and Changing, Security and Protection, Functions and Relationships. Therefore, in relation to the factors, it was conclude that nursing diagnosis help nurses to understand the unsettled human answers or the risks to disturbance in an individual way, which contributes to plan specific interventions to these patients. It was possible to verify that the stage of the nursing diagnosis that is part of the nursing process should be executed by the nurses systematically, because it has been realized by the nurses’ clinical idea, but not in a systematical way

Mapeamento do nível radiométrico e construção de mapa espacial em serviço de medicina nuclear

Nuclear Medicine is a medical modality of therapy and diagnostic imaging using unsealed radioactive sources for its purposes. This routine activity promotes the transit of radioactive sources for the area of installation, beyond the transit of patients injected with radioisotope, which also contribute to raising the radiometric level of environment. As a consequence, it has exposured workers and public individuals to the ionizing radiation. There are protective mechanisms of radiation exposure, personal protective equipments, and measurement planes established in standard measurement at certain points of the environment in order to identify any increase in radiometric levels and \ or contamination, but do not cover the entire space occupied by workers and patients. To accomplish with the individual dose limits established by the National Commission of Nuclear Energy, it is interesting if there is an individualized classification for each Nuclear Medicine service. This work aimed to promote an analysis of the radiometric level distribution across the extent of the Technical Nuclear Medicine Sector of Hospital of the Botucatu Medical School, and produce a spatial map to identify locations with higher exposure rate to the ionizing radiation, can be used as a risk map to assist the Occupationally Exposed Individuals (IOE). To perform the radiometric levels checking it was used a digital Geiger-Muller detector available in the sector, due to its practicality compared to other detectors. Measurements were carried out at four different times for all days of the week, at points strategically established to cover all the installation

Fotografias escolares: a leitura de imagens na história da escola primária

This research consists in photograph reading, more specifically, school photographs related to primary teaching in the city of Campinas, between 1897 and 1950. It is based on a heritage constituted of 55 images that analyzes four categories of photographs: school architecture, student classes, teaching body and school activities, these categories illustrate the discourse about school, human contexts and social relations revealed by those images. The text also focuses the iconography documentation relevance for History of Education research, specially, about educational institutions.

How to progress from discourse to practice? a new agenda for change in medical schools into the next decade

In the context of medical school instruction, the segmented approach of a focus on specialties and excessive use of technology seem to hamper the development of the professional-patient relationship and an understanding of the ethics of this relationship. The real world presents complexities that require multiple approaches. Engagement in the community where health competence is developed allows extending the usefulness of what is learned. Health services are spaces where the relationship between theory and practice in health care are real and where the social role of the university can be revealed. Yet some competencies are still lacking and may require an explicit agenda to enact. Ten topics are presented for focus here: environmental awareness, involvement of students in medical school, social networks, interprofessional learning, new technologies for the management of care, virtual reality, working with errors, training in management for results, concept of leadership, and internationalization of schools. Potential barriers to this agenda are an underinvestment in ambulatory care infrastructure and community-based health care facilities, as well as in information technology offered at these facilities; an inflexible departmental culture; and an environment centered on a discipline-based medical curriculum.

Medical Students' Attitudes Toward The Medical College Admission Test

The following study analyzed the attitudes held by pre-clinical medical students about the Medical College Admission Test or MCAT. One hundred and eighty first-year and second-year medical students at a public Midwestern medical university participated in this study. Participants completed the “Medical Students Attitudes toward the Medical College Admission Test” survey during their morning lectures near the end of their spring semester. A composite scale score of the Likert items of the survey was computed and the proportion of students with attitudes ranging from strongly agree to strongly disagree was calculated. For six of the twelve Likert items the largest proportion of participants disagreed with the statements about the MCAT and its use in the admission process and its applicability to their current medical education. Other questions included how participants prepared for the MCAT and if they completed each of the subsections were addressed as well. Future research could determine if attitudes between students accepted into medical school and those not accepted are drastically different. Advisor: Kurt F. Geisinger

Leprosy reactions: coinfections as a possible risk factor

OBJECTIVE: This study aimed to determine the frequency of coinfections in leprosy patients and whether there is a relationship between the presence of coinfections and the development of leprosy reactional episodes. METHOD: A cross-sectional study based on an analysis of the medical records of the patients who were treated at the Leprosy Clinics of the Ribeirao Preto Medical School, University of Sao Paulo, was conducted from 2000 to 2010. Information was recorded regarding the age, sex, clinical status, WHO classification, treatment, presence of reactions and coinfections. Focal and systemic infections were diagnosed based on the history, physical examination, and laboratory tests. Multinomial logistic regression was used to evaluate the associations between the leprosy reactions and the patients' gender, age, WHO classification and coinfections. RESULTS: Two hundred twenty-five patients were studied. Most of these patients were males (155/225 = 68.8%) of an average age of 49.31 +/- 15.92 years, and the most prevalent clinical manifestation was the multibacillary (MB) form (n = 146), followed by the paucibacillary (PB) form (n = 79). Erythema nodosum leprosum (ENL) was more prevalent (78/122 = 63.9%) than the reversal reaction (RR) (44/122 = 36.1%), especially in the MB patients (OR 5.07; CI 2.86-8.99; p<0.0001) who exhibited coinfections (OR 2.26; CI 1.56-3.27; p<0.0001). Eighty-eight (88/225 = 39.1%) patients exhibited coinfections. Oral coinfections were the most prevalent (40/88 = 45.5%), followed by urinary tract infections (17/88 = 19.3%), sinusopathy (6/88 = 6.8%), hepatitis C (6/88 = 6.8%), and hepatitis B (6/88 = 6.8%). CONCLUSIONS: Coinfections may be involved in the development and maintenance of leprosy reactions.

Does ragging play a role in medical student depression - Cause or effect?

Background: Medical students experience a lot of stress what may contribute to symptoms of depression. In this study we set out to look at the environmental factors which may be contributing in one medical school in Brazil. Methods: We assessed depressive symptoms using Beck's Depression Inventory in 465 and 267 medical students in 2001 and 2006 respectively. We explored possible social and environmental causes using qualitative data. Results: Nearly 15% scored above the cut off for depression in both the samples. Males in the pre-clinical stage in 2006 showed an increase in depressive symptoms than males in the same cycle in 2001 (aOR = 7.36 [95% CI = 0.85-63.5] p = 0.07). Qualitative data confirmed that factors such as ragging and low social involvement were correlated with depressive symptoms in pre-clinical stage males. Limitations: The sample size was small both for quantitative and qualitative aspects of the study. Conclusions: It appears that ragging plays an important role in the genesis of depressive symptoms in medical students. (C) 2012 Elsevier B.V. All rights reserved.

What do medical students think about their quality of life? A qualitative study

Background: Medical education can affect medical students' physical and mental health as well as their quality of life. The aim of this study was to assess medical students' perceptions of their quality of life and its relationship with medical education. Methods: First-to sixth-year students from six Brazilian medical schools were interviewed using focus groups to explore what medical student's lives are like, factors related to increases and decreases of their quality of life during medical school, and how they deal with the difficulties in their training. Results: Students reported a variety of difficulties and crises during medical school. Factors that were reported to decrease their quality of life included competition, unprepared teachers, excessive activities, and medical school schedules that demanded exclusive dedication. Contact with pain, death and suffering and harsh social realities influence their quality of life, as well as frustrations with the program and insecurity regarding their professional future. The scarcity of time for studying, leisure activities, relationships, and rest was considered the main factor of influence. Among factors that increase quality of life are good teachers, classes with good didactic approaches, active learning methodologies, contact with patients, and efficient time management. Students also reported that meaningful relationships with family members, friends, or teachers increase their quality of life. Conclusion: Quality of teachers, curricula, healthy lifestyles related to eating habits, sleep, and physical activity modify medical students' quality of life. Lack of time due to medical school obligations was a major impact factor. Students affirm their quality of life is influenced by their medical school experiences, but they also reframe their difficulties, herein represented by their poor quality of life, understood as necessary and inherent to the process of becoming doctors.

Forecasting the need for medical specialists in Spain: application of a system dynamics model

[EN] Background: Spain has gone from a surplus to a shortage of medical doctors in very few years. Medium and long-term planning for health professionals has become a high priority for health authorities. Methods: We created a supply and demand/need simulation model for 43 medical specialties using system dynamics. The model includes demographic, education and labour market variables. Several scenarios were defined. Variables controllable by health planners can be set as parameters to simulate different scenarios. The model calculates the supply and the deficit or surplus. Experts set the ratio of specialists needed per 1000 inhabitants with a Delphi method. Results: In the scenario of the baseline model with moderate population growth, the deficit of medical specialists will grow from 2% at present (2800 specialists) to 14.3% in 2025 (almost 21 000). The specialties with the greatest medium-term shortages are Anesthesiology, Orthopedic and Traumatic Surgery, Pediatric Surgery, Plastic Aesthetic and Reparatory Surgery, Family and Community Medicine, Pediatrics, Radiology, and Urology. Conclusions: The model suggests the need to increase the number of students admitted to medical school. Training itineraries should be redesigned to facilitate mobility among specialties. In the meantime, the need to make more flexible the supply in the short term is being filled by the immigration of physicians from new members of the European Union and from Latin America.