The risk factors for fractures and trabecular bone-score value in patients with endogenous Cushing's syndrome.

In a cohort study of 182 consecutive patients with active endogenous Cushing's syndrome, the only predictor of fracture occurrence after adjustment for age, gender bone mineral density (BMD) and trabecular bone score (TBS) was 24-h urinary free cortisol (24hUFC) levels with a threshold of 1472 nmol/24 h (odds ratio, 3.00 (95 % confidence interval (CI), 1.52-5.92); p = 0.002). INTRODUCTION: The aim was to estimate the risk factors for fracture in subjects with endogenous Cushing's syndrome (CS) and to evaluate the value of the TBS in these patients. METHODS: All enrolled patients with CS (n = 182) were interviewed in relation to low-traumatic fractures and underwent lateral X-ray imaging from T4 to L5. BMD measurements were performed using a DXA Prodigy device (GEHC Lunar, Madison, Wisconsin, USA). The TBS was derived retrospectively from existing BMD scans, blinded to clinical outcome, using TBS iNsight software v2.1 (Medimaps, Merignac, France). Urinary free cortisol (24hUFC) was measured by immunochemiluminescence assay (reference range, 60-413 nmol/24 h). RESULTS: Among enrolled patients with CS (149 females; 33 males; mean age, 37.8 years (95 % confidence interval, 34.2-39.1); 24hUFC, 2370 nmol/24 h (2087-2632), fractures were confirmed in 81 (44.5 %) patients, with 70 suffering from vertebral fractures, which were multiple in 53 cases; 24 patients reported non-vertebral fractures. The mean spine TBS was 1.207 (1.187-1.228), and TBS Z-score was -1.86 (-2.07 to -1.65); area under the curve (AUC) was used to predict fracture (mean spine TBS) = 0.548 (95 % CI, 0.454-0.641)). In the final regression model, the only predictor of fracture occurrence was 24hUFC levels (p = 0.001), with an increase of 1.041 (95 % CI, 1.019-1.063), calculated for every 100 nmol/24-h cortisol elevation (AUC (24hUFC) = 0.705 (95 % CI, 0.629-0.782)). CONCLUSIONS: Young patients with CS have a low TBS. However, the only predictor of low traumatic fracture is the severity of the disease itself, indicated by high 24hUFC levels.

Utilización de los apuntes de clase en las carreras de Enfermería y Medicina de la Universidad de Barcelona

Objetivo: Analizar aspectos relacionados con los apuntes que toman los alumnos de Enfermería y Medicina en el transcurso de las respectivas clases. Se comparan cuestiones relacionadas con la revisión, conservación, consulta, préstamo, etc. de los apuntes. Además, se identifican los recursos bibliográficos empleados (artículos, libros, Internet, etc.) como complemento de los apuntes y el uso que se les prevé dar en el futuro. Diseño: Descriptivo y transversal. Emplazamiento: Facultad de Medicina y Escuela de Enfermería de la Universidad de Barcelona. Período de estudio: desde noviembre de 2000 a febrero de 2001. Participantes: Estudiantes del último curso de Medicina y de Enfermería que asistían a una asignatura troncal. Se trata de una muestra no probabilística de conveniencia. Mediciones: Para la obtención de los datos se empleó una encuesta autoadministrada compuesta de 27 preguntas de respuesta múltiple que fue sometida una prueba piloto. Las variables estudiadas fueron: frecuencia en la toma de apuntes, material utilizado, revisión, préstamo, recursos documentales complementarios y su posible uso en el futuro profesional. Resultados principales: Se estudió a 299 sujetos: 168 (56, 19%) pertenecen a la carrera de Enfermería y 131 (43,81%) a la de Medicina. En la muestra, 254 (84,95%) son mujeres y 45 (15,05%) varones. Las medias de edad son de 22,69 (desviación estándar [DE]: 2,84) y 23,47 (DE: 2,56), respectivamente. Se aprecian diferencias estadísticamente significativas en la frecuencia en que se toman apuntes (x2 15,21; df 3; p = 0,002) y en el pasarlos a limpio (x2 66,71; df 3; p < 0,001) a favor de Enfermería; en cambio, se revisan con mayor frecuencia en Medicina (x2 23,04; df 3; p < 0,001). No se observan diferencias en la frecuencia, razones y actitud relacionada con el préstamo de apuntes. En Medicina se complementan los apuntes con mayor frecuencia que en Enfermería (x2 23,16; df 4; p < 0,001). Se tiene intención de guardar y consultar los apuntes sobre todo en Enfermería (x2 144,83; df 1; p < 0,001 ). Conclusiones: los apuntes son considerados como el principal recurso para la preparación de los exámenes en ambas carreras. En Enfermería se les asigna un mayor valor para la realización de la carrera y como material de consulta en el futuro; en tanto que en Medicina es más habitual complementarlos con otros materiales bibliográficos.

Utilización de los apuntes de clase en las carreras de Enfermería y Medicina de la Universidad de Barcelona

Objetivo: Analizar aspectos relacionados con los apuntes que toman los alumnos de Enfermería y Medicina en el transcurso de las respectivas clases. Se comparan cuestiones relacionadas con la revisión, conservación, consulta, préstamo, etc. de los apuntes. Además, se identifican los recursos bibliográficos empleados (artículos, libros, Internet, etc.) como complemento de los apuntes y el uso que se les prevé dar en el futuro. Diseño: Descriptivo y transversal. Emplazamiento: Facultad de Medicina y Escuela de Enfermería de la Universidad de Barcelona. Período de estudio: desde noviembre de 2000 a febrero de 2001. Participantes: Estudiantes del último curso de Medicina y de Enfermería que asistían a una asignatura troncal. Se trata de una muestra no probabilística de conveniencia. Mediciones: Para la obtención de los datos se empleó una encuesta autoadministrada compuesta de 27 preguntas de respuesta múltiple que fue sometida una prueba piloto. Las variables estudiadas fueron: frecuencia en la toma de apuntes, material utilizado, revisión, préstamo, recursos documentales complementarios y su posible uso en el futuro profesional. Resultados principales: Se estudió a 299 sujetos: 168 (56, 19%) pertenecen a la carrera de Enfermería y 131 (43,81%) a la de Medicina. En la muestra, 254 (84,95%) son mujeres y 45 (15,05%) varones. Las medias de edad son de 22,69 (desviación estándar [DE]: 2,84) y 23,47 (DE: 2,56), respectivamente. Se aprecian diferencias estadísticamente significativas en la frecuencia en que se toman apuntes (x2 15,21; df 3; p = 0,002) y en el pasarlos a limpio (x2 66,71; df 3; p < 0,001) a favor de Enfermería; en cambio, se revisan con mayor frecuencia en Medicina (x2 23,04; df 3; p < 0,001). No se observan diferencias en la frecuencia, razones y actitud relacionada con el préstamo de apuntes. En Medicina se complementan los apuntes con mayor frecuencia que en Enfermería (x2 23,16; df 4; p < 0,001). Se tiene intención de guardar y consultar los apuntes sobre todo en Enfermería (x2 144,83; df 1; p < 0,001 ). Conclusiones: los apuntes son considerados como el principal recurso para la preparación de los exámenes en ambas carreras. En Enfermería se les asigna un mayor valor para la realización de la carrera y como material de consulta en el futuro; en tanto que en Medicina es más habitual complementarlos con otros materiales bibliográficos.

The promoter activity of human Mfn2 depends on Sp1 in vascular smooth muscle cells

AIMS: Mitofusin-2 (Mfn2) expression is dysregulated in vascular proliferative disorders and its overexpression attenuates the proliferation of vascular smooth muscle cells (VSMCs) and neointimal lesion development after balloon angioplasty. We sought to gain insight into the mechanisms that control Mfn2 expression in VSMCs. METHODS AND RESULTS: We cloned and characterized 2 kb of the 5'-flanking region of the human Mfn2 gene. Its TATA-less promoter contains a CpG island. In keeping with this, 5'-rapid amplification of cDNA ends revealed six transcriptional start sites (TSSs), of which TSS2 and TSS5 were the most frequently used. The strong CpG island was found to be non-methylated under conditions characterized by large differences in Mfn2 gene expression. The proximal Mfn2 promoter contains six putative Sp1 motifs. Sp1 binds to the Mfn2 promoter and its overexpression activates the Mfn2 promoter in VSMCs. Chemical inhibition of Sp1 reduced Mfn2 expression, and Sp1 silencing reduced transcriptional activity of the Mfn2 promoter. In keeping with this view, Sp1 and Mfn2 mRNA levels were down-regulated in the aorta early after an atherogenic diet in apolipoprotein E-knockout mice or in VSMCs cultured in the presence of low serum. CONCLUSION: Sp1 is a key factor in maintaining basal Mfn2 transcription in VSMCs. Given the anti-proliferative actions of Mfn2, Sp1-induced Mfn2 transcription may represent a mechanism for prevention of VSMC proliferation and neointimal lesion and development.

The promoter activity of human Mfn2 depends on Sp1 in vascular smooth muscle cells

AIMS: Mitofusin-2 (Mfn2) expression is dysregulated in vascular proliferative disorders and its overexpression attenuates the proliferation of vascular smooth muscle cells (VSMCs) and neointimal lesion development after balloon angioplasty. We sought to gain insight into the mechanisms that control Mfn2 expression in VSMCs. METHODS AND RESULTS: We cloned and characterized 2 kb of the 5'-flanking region of the human Mfn2 gene. Its TATA-less promoter contains a CpG island. In keeping with this, 5'-rapid amplification of cDNA ends revealed six transcriptional start sites (TSSs), of which TSS2 and TSS5 were the most frequently used. The strong CpG island was found to be non-methylated under conditions characterized by large differences in Mfn2 gene expression. The proximal Mfn2 promoter contains six putative Sp1 motifs. Sp1 binds to the Mfn2 promoter and its overexpression activates the Mfn2 promoter in VSMCs. Chemical inhibition of Sp1 reduced Mfn2 expression, and Sp1 silencing reduced transcriptional activity of the Mfn2 promoter. In keeping with this view, Sp1 and Mfn2 mRNA levels were down-regulated in the aorta early after an atherogenic diet in apolipoprotein E-knockout mice or in VSMCs cultured in the presence of low serum. CONCLUSION: Sp1 is a key factor in maintaining basal Mfn2 transcription in VSMCs. Given the anti-proliferative actions of Mfn2, Sp1-induced Mfn2 transcription may represent a mechanism for prevention of VSMC proliferation and neointimal lesion and development.

Dosimetric evaluation of X-ray examinations of paranasal sinuses in pediatric patients

Abstract Objective: To estimate the entrance surface air kerma (Ka,e) and air kerma in the region of radiosensitive organs in radiographs of pediatric paranasal sinuses. Materials and Methods: Patient data and irradiation parameters were collected in examinations of the paranasal sinuses in children from 0 to 15 years of age at two children's hospitals in the city of Recife, PE, Brazil. We estimated the Ka,e using the X-ray tube outputs and selected parameters. To estimate the air kerma values in the regions of the eyes and thyroid, we used thermoluminescent dosimeters. Results: The Ka,e values ranged from 0.065 to 1.446 mGy in cavum radiographs, from 0.104 to 7.298 mGy in Caldwell views, and from 0.113 to 7.824 mGy in Waters views. Air kerma values in the region of the eyes ranged from 0.001 to 0.968 mGy in cavum radiographs and from 0.011 to 0.422 mGy in Caldwell and Waters views . In the thyroid region, air kerma values ranged from 0.005 to 0.932 mGy in cavum radiographs and from 0.002 to 0.972 mGy in Caldwell and Waters views. Conclusion: The radiation levels used at the institutions under study were higher than those recommended in international protocols. We recommend that interventions be initiated in order to reduce patient exposure to radiation and therefore the risks associated with radiological examination of the paranasal sinuses.

Predictors of remission in the treatment of major depressive disorder: real-world evidence from a 6-month prospective observational study

BACKGROUND: This study examined potential predictors of remission among patients treated for major depressive disorder (MDD) in a naturalistic clinical setting, mostly in the Middle East, East Asia, and Mexico. METHODS: Data for this post hoc analysis were taken from a 6-month prospective, noninterventional, observational study that involved 1,549 MDD patients without sexual dysfunction at baseline in 12 countries worldwide. Depression severity was measured using the Clinical Global Impression of Severity and the 16-item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16). Depression-related pain was measured using the pain-related items of the Somatic Symptom Inventory. Remission was defined as a QIDS-SR16 score ≤5. Generalized estimating equation regression models were used to examine baseline factors associated with remission during follow-up. RESULTS: Being from East Asia (odds ratio [OR] 0.48 versus Mexico; P<0.001), a higher level of depression severity at baseline (OR 0.77, P=0.003, for Clinical Global Impression of Severity; OR 0.92, P<0.001, for QIDS-SR16), more previous MDD episodes (OR 0.92, P=0.007), previous treatments/therapies for depression (OR 0.78, P=0.030), and having any significant psychiatric and medical comorbidity at baseline (OR 0.60, P<0.001) were negatively associated with remission, whereas being male (OR 1.29, P=0.026) and treatment with duloxetine (OR 2.38 versus selective serotonin reuptake inhibitors, P<0.001) were positively associated with remission. However, the association between Somatic Symptom Inventory pain scores and remission no longer appeared to be significant in this multiple regression (P=0.580), (P=0.008 in descriptive statistics), although it remained significant in a subgroup of patients treated with selective serotonin reuptake inhibitors (OR 0.97, P=0.023), but not in those treated with duloxetine (P=0.182). CONCLUSION: These findings are largely consistent with previous reports from the USA and Europe. They also highlight the potential mediating role of treatment with duloxetine on the negative relationship between depression-related pain and outcomes of depression.

Energia de superfície para nanossuperfícies de TiO2 na direção (001)

In this work was made an investigation about bulk and surface models (at maximum 20 layers) of the TiO2 material in the (001) direction. TiO2 commercial sample was feature using XDR technique to determine phase and crystallites average size. Bulk and (001) surface models were simulated for TiO2 material using DFT/B3LYP and its results were used for calculating energy surface, electronic levels, superficial atomic displacement and charge maps. Atoms of the first and second layers of the slab model showed electronic densities very well organized in the form of chains or wires.

Biochemical characterisation of lipase from a new strain of Bacillus sp. ITP-001

Lipases are characterised mainly by catalytic versatility and application in different industrial segments. The aim of this study was to biochemically characterise a lipase from a new strain of Bacillus sp. ITP-001. The isoelectric point and molecular mass were 3.12 and 54 kDa, respectively. The optima lipase activity was 276 U g-1 at pH 7.0 and a temperature of 80 ºC, showing greater stability at pH 5.0 and 37 ºC. Enzymatic activity was stimulated by various ions and pyridine, and inhibited by Cu+ and ethanol. The values of Km and v max were 105.26 mmol and 0.116 mmol min-1 g-1, respectively determined by the Eadie-Scatchard method.

Biochemical properties of Bacillus sp. ITP-001 lipase immobilized with a sol gel process

This work presents biochemical characterization of a lipase from a new strain of Bacillus sp. ITP-001, immobilized using a sol gel process (IB). The results from the biochemical characterization of IB showed increased activity for hydrolysis, with 526.63 U g-1 at pH 5.0 and 80 ºC, and thermal stability at 37 ºC. Enzymatic activity was stimulated by ions such as EDTA, Fe+3, Mn+2, Zn+2, and Ca+2, and in various organic solvents. Kinetic parameters obtained for the IB were Km = 14.62 mM, and Vmax = 0.102 mM min-1 g-1. The results of biochemical characterization revealed the improved catalytic properties of IB.

Kumppanuusohjelman strateginen johtaminen - Monitapaustutkimus puolustushallinnossa

Puolustushallinnossa syntyi 2000-luvun alussa strateginen aie keskittyä ydintoimintoihin, ulkoistaa pääosa tukitoiminnoista ja saavuttaa kustannussäästöjä, jotka voitaisiin kohdentaa ydintoimintoihin. Puolustusministeriö perusti ulkoistamisen hallinnoimiseksi kumppanuusohjelman, mihin kuului lähes alusta alkaen kuusi hanketta, jotka ovat nyt toteuttamisvaiheessa. Näistä valittiin neljä tähän tutkimukseen: maavoimien materiaalin kunnossapito, puolustusvoimien ruokahuolto, puolustusvoimien vaatetushuolto ja puolustushallinnon talous- ja henkilöstöhallinto. Kumppanuusohjelman strategisen johtamisen tutkimus perustuupuolustusministeriön ja puolustusvoimien asiakirja-aineistoihin sekä puolustushallinnon ylimmän johdon ja hankejohtajien haastatteluihin. Kumppanuusohjelmaa ja -hankkeita on seurattu vuodesta 2000 vuoden 2010 kevääseen asti. Tarkastelu kohdistuu strategiaprosessiin ja strategian sisältöön ”puolustushallinnon konsernissa”, johon kuuluvat tässä tutkimuksessa puolustusministeriö, pääesikunta ja puolustushaarat. Tutkimuksen tulokset tukevat viitekehyksessä esitettyjä näkökohtia. Laajan kumppanuusohjelman hallinta edellyttää hyvää strategisen johtamisen otetta. Selkeät päämäärät ja tavoitteet luovat perustan strategiaprosessille. Kumppanuusohjelman strategia muotoutui tarkastelujakson aikana niin strategiaprosessien kuin strategian sisällön suhteen. Toimiva ohjausjärjestelmä on puolustushallinnon avaintoimintoja strategisessa johtamisessa. Resurssiperusteinen strategia osoittautui tärkeäksi ulkoistamisissa ja sosiaalinen pääoma, erityisesti yhteisymmärrys osoittautui tärkeäksi tekijäksi konsernijohtamisessa. Kumppanuusohjelman strategisen johtamisen toimivuuden kehittämiseksi kartoitettiin tekijöitä, jotka muodostuivat tehokkaan strategisen johtamisen esteiksi. Esteitä kartoitettiin kumppanuusohjelmasta ja -hankkeista. Tutkimuksen tärkein kontribuutio kohdistuu strategisen johtamisen kehittämiseen. Se on mahdollista hankkimalla konsernin johtotasoilla yhteisymmärryskehittämisohjelmasta ennen ohjelman käynnistämistä, ottamalla huomioon strategisen johtamisen perusteet, ottamalla käyttöön jatkuva strategiaprosessi ja turvaamalla riittävä osaaminen kumppanuusohjelmassa ja -hankkeissa.

Online Ultrasound Measurements of Membrane Compaction

There are several filtration applications in the pulp and paper industry where the capacity and cost-effectiveness of processes are of importance. Ultrafiltration is used to clean process water. Ultrafiltration is a membrane process that separates a certain component or compound from a liquid stream. The pressure difference across the membrane sieves macromolecules smaller than 0.001-0.02 μm through the membrane. When optimizing the filtration process capacity, online information about the conditions of the membrane is needed. Fouling and compaction of the membrane both affect the capacity of the filtration process. In fouling a “cake” layer starts to build on the surface of the membrane. This layer blocks the molecules from sieving through the membrane thereby decreasing the yield of the process. In compaction of the membrane the structure is flattened out because of the high pressure applied. The higher pressure increases the capacity but may damage the structure of the membrane permanently. Information about the compaction is needed to effectively operate the filters. The objective of this study was to develop an accurate system for online monitoring of the condition of the membrane using ultrasound reflectometry. Measurements of ultrafiltration membrane compaction were made successfully utilizing ultrasound. The results were confirmed by permeate flux decline, measurements of compaction with a micrometer, mechanical compaction using a hydraulic piston and a scanning electron microscope (SEM). The scientific contribution of this thesis is to introduce a secondary ultrasound transducer to determine the speed of sound in the fluid used. The speed of sound is highly dependent on the temperature and pressure used in the filters. When the exact speed of sound is obtained by the reference transducer, the effect of temperature and pressure is eliminated. This speed is then used to calculate the distances with a higher accuracy. As the accuracy or the resolution of the ultrasound measurement is increased, the method can be applied to a higher amount of applications especially for processes where fouling layers are thinner because of smaller macromolecules. With the help of the transducer, membrane compaction of 13 μm was measured in the pressure of 5 bars. The results were verified with the permeate flux decline, which indicated that compaction had taken place. The measurements of compaction with a micrometer showed compaction of 23–26 μm. The results are in the same range and confirm the compaction. Mechanical compaction measurements were made using a hydraulic piston, and the result was the same 13 μm as obtained by applying the ultrasound time domain reflectometry (UTDR). A scanning electron microscope (SEM) was used to study the structure of the samples before and after the compaction.

Hypoxia-associated biomarkers in rectal cancer treated by preoperative radiotherapy or chemoradiotherapy

Hypoksiaan liittyvät biologiset merkkiaineet leikkausta edeltävällä sädehoidolla tai kemosädehoidolla hoidetussa peräsuolisyövässä Peräsuolensyöpä on yleinen pahanlaatuinen kasvain. Leikkausta edeltävä sädehoito annetaan yleensä T3-T4-kasvaimille. Tutkimuksella pyrittiin selvittämään, voidaanko kasvaimen hapenpuutteeseen liittyvillä biologisilla merkkiaineilla arvioida peräsuolisyövän ennustetta leikkausta edeltävän sädehoidon tai kemosädehoidon jälkeen. Tällaisia merkkiaineita ovat hapenpuutteen vaikutuksesta aktivoituva HIF-1alfa hiilihappoanhydraasi IX (CA IX), sokerin kuljetukseen solussa osallistuva GLUT-1 sekä solun tukirankaproteiini ezrin. Tutkimukseen otettiin 178 potilasta, jotka olivat saaneet ennen leikkausta lyhyen (n=77) tai pitkän sädehoidon (n=10), pitkän sädehoidon ja solunsalpaajahoidon (n=37) tai ei mitään hoitoa (n=54). Lisäksi osalta leikkausta edeltävää sädehoitoa saaneelta potilaalta tutkittiin hoitoja edeltävät, diagnostiset näytteet (n=80). Tutkimuksessa käytettiin immunehistokemiallisia värjäysmenetelmiä. Kasvaimen regressiota (TRG) arvioitiin pitkän sädehoidon jälkeisistä näytteistä. Leikkausnäytteissä negatiivinen/heikko CA IX intensiteetti liittyi sekä pidempään tautispesifiseen (p=0.034) että tautivapaaseen elinaikaan (p=0.003) ja pitkän sädehoidon jälkeen HIF-1alfa-negatiivisuus pidempään tautispesifiseen (p=0.001) sekä negatiivinen/heikko GLUT-1 pidempään tautivapaaseen elinaikaan (p=0.066). Voimakas ezrin-ilmentymä diagnostisissa näytteissä liittyi lyhyempään tautivapaaseen ja tautispesifiseen (p=0.027 ja p=0.002) ennusteeseen. Monimuuttuja-analyysissä vahva CA IX intensiteetti leikkausnäytteissä ennusti itsenäisesti huonompaa tautivapaata ja tautispesifistä selviytymistä. Erinomainen TRG liittyi negatiiviseen/heikkoon CA IX- (p=0.057), ezrin- (p=0.012) ja GLUT-1 -ilmentymään (p=0.013) leikkausnäytteissä. Kun kaikki neljä merkkiainetta analysoitiin yhdessä monimuuttuja-analyysissä, CA IX intensiteetti leikkausnäytteissä ennusti itsenäisesti tautispesifistä elinaikaa. Voimakas CA IX-ilmentymä leikkausnäytteissä ja positiivinen HIF-1alfa- ja vahva GLUT-1-ilmentymä pitkän sädehoidon jälkeisissä leikkausnäytteissä sekä vahva ezrin-ilmentymä diagnostisissa näytteissä liittyivät epäsuotuisaan ennusteeseen. Monimuuttujaanalyysissä kohtalainen/voimakas CA IX intensiteetti leikkausnäytteissä ennusti itsenäisesti huonompaa tautivapaata ja tautispesifistä elinaikaa. CA IX on vahva biologinen merkkiaine peräsuolisyövässä.

Videoaula ou teleconsultoria no aprendizado em otorrinolaringologia do médico de família

OBJETIVO: Comparar diferentes métodos de aprendizagem em Otorrinolaringologia para médicos de família. MÉTODOS: Os médicos foram distribuídos aleatoriamente em três grupos: 12 foram expostos a instruções verbais com uso de videoaulas, 12 a teleconsultoria com especialista, e 13 a ambas as técnicas. Antes e depois das intervenções nos grupos, foi aplicado um questionário com tarefas em Otorrinolaringologia. Comparou-se o número de acertos no questionário com os casos encaminhados da Atenção Primária à Secundária e a concordância entre diagnósticos da Atenção Primária e Secundária. RESULTADOS: Após as intervenções, houve melhora no conhecimento para os grupos exposição verbal com videoaulas (p = 0,002) e teleconsultoria/videoaula (p = 0,001), queda de 16% no número de encaminhamentos da Atenção Primária para a Secundária. Não foi observada em qualquer dos grupos concordância de diagnósticos entre a Atenção Primária e Secundária, com Kappa abaixo de 0,75. CONCLUSÃO: O médico de família aprendeu mais Otorrinolaringologia com instruções verbais em videoaulas do que com teleconsultoria com especialista. No entanto, ele não foi capaz de usar o conhecimento adquirido para fazer diagnósticos concordantes com os do especialista.

Aula centrada no aluno versus aula centrada no professor: desafios para mudança

INTRODUÇÃO: As diretrizes curriculares nacionais recomendam estratégias de ensino centradas nos estudantes. Este estudo avaliou a aceitação, o comportamento e a aprendizagem dos alunos do quarto ano de Ginecologia em relação a aulas centradas no professor (ACP) e aulas centradas nos alunos (ACA). MÉTODOS: Estudo prospectivo para 110 alunos ao longo do ano. Três professores participaram do estudo, cada um com dois temas (um em cada formato de aula). O interesse e o comportamento dos alunos foram registrados. Os alunos responderam a questionário semiestruturado, a duas perguntas abertas e foram avaliados ao final. RESULTADOS: A frequência dos alunos (76,4 x 53,9% p = 0,002), o número de cochilos (40 x 10 p < 0,001) e a percentagem de acertos na avaliação foram maiores nas ACP (69,9 x 59,3% p = 0,016). A duração da atividade foi maior na ACA (89,5 versus 68,4 minutos (p = 0,014), e o número de interações aluno-professor foi maior nas ACA (500 x 310). Os alunos sugeriram manter ACP (79,7 x 31,4% p < 0,001). CONCLUSÕES: Os estudantes preferiram ACP. Este artigo discute possíveis razões destes achados e estratégias de mudança nas práticas de ensino.