International recommendations for training future toxicologic pathologists participating in regulatory-type, nonclinical toxicity studies

The International Federation of Societies of Toxicologic Pathologists (IFSTP) proposes a common global framework for training future toxicologic pathologists who will support regulatory-type - nonclinical toxicology studies. Trainees optimally should undertake a scientific curriculum of at least 5 years at an accredited institution leading to a clinical degree (veterinary medicine or medicine). Trainees should then obtain 4 or more years of intensive pathology practice during a residency and/or on-the-job "apprenticeship," at least 2 years of which must be focused on regulatory-type toxicologic pathology topics. Possession of a recognized pathology qualification (i.e., certification) is highly recommended. A nonclinical pathway (e.g., a graduate degree in medical biology or pathology) may be possible if medically trained pathologists are scarce, but this option is not optimal. Regular, lifelong continuing education (peer review of nonclinical studies, professional meetings, reading, short courses) will be necessary to maintain and enhance one's understanding of current toxicologic pathology knowledge, skills, and tools. This framework should provide a rigorous yet flexible way to reliably train future toxicologic pathologists to generate, interpret, integrate, and communicate data in regulatory-type, nonclinical toxicology studies. (C) 2010 Reprinted by Permission of SAGE Publications Inc. Published by Elsevier GmbH. All rights reserved.

Psicoterapia grupal no transtorno obsessivo-compulsivo

There are few published papers about group psychotherapy for patients with obsessive-compulsive disorder (OCD), and usually restricted psychoeducational, support or cognitive-behavioral approaches. This article describes the experience of group psychotherapy for OCD patients started in 1996 in Botucatu Medical School - Unesp, São Paulo, Brazil. The two-hour sessions occur once a month, with 6 to 10 female patients, and are based on psychodramatic techniques. Psychotropic prescriptions are given after the sessions. In the beginning, aggressive obsessions were more prominent and were reported with much anguish and shame. Gradually, the themes changed from OCD specific issues (symptoms, pharmacological treatment, outcome, need of exposure and response prevention) to deeper and more personal psychodynamic aspects. The psychodramatic approach (techniques of double, mirror, role inversion, search for prymary scenes) has mostly shown: difficulty in accepting their own human mistakes or negative emotions due to excessive personal demands. This seems to generate guilt, low self-esteem, idealization of others, difficulty in enjoying pleasant situations, fear of taking responsibilities and of losing control (madness/aggressiveness). The group has been considered very important by the patients, since sharing experiences helps to diminish feelings of isolation, shame and guilt, stimulates the exposure to feared situations and enhances self-esteem. The fact that all participants have the same disorder favors group cohesion and provides relief, as they see in the others some of their afflictions and are able to share similar feelings and experiences. Many times the burden of the symptoms are dealt with humor. The confidence in such therapeutic setting is helping the identification and resolution of personal conflicts and contributing to the adherence to pharmacological treatment. The group also provides valuable training experiences for resident physicians in psychiatry.

Pediatras e os distúrbios respiratórios do sono na criança

OBJECTIVES. assessment of opinions and practices of pediatricians concerning sleep-disordered breathing (SDB) in children. Methods. randomly 516 pediatricians were selected in the state of São Paulo, Brazil. A survey mailed to them included questions regarding: their professional profile, knowledge about SDB in childhood, opinions and practices for diagnosis and treatment of these diseases. RESULTS. 112 anonymous completed surveys were returned (21.7%). The teaching of SDB during medical school and pediatric residency training was considered unsatisfactory respectively by 65.2% and 34.8% of the pediatricians. Forty-nine respondents (43.8%) rated their knowledge about SDB in children as regular, 39 (34.8%) as good and 17 (15.2%) as unsatisfactory. The most important sleep-related questions were: mouth breathing, breathing pauses, sleep amount, excessive daytime sleepiness and nocturnal wheezing. Clinical aspects regarded as the most significant for suspecting obstructive sleep apnea syndrome (OSAS) were: breathing pauses, adenoid hypertrophy, mouth breathing, craniofacial anomaly and snoring. The most frequent practices for evaluation of OSAS in children were: cavum radiography with referral to an otorhinolarnygologist (25%) and nocturnal pulse oximetry (14.2%). Only 11.6% of pediatricians recommended overnight polysomnography and 4.5%, nap polysomnography. The most effective practices for SDB were considered to be: adenoidectomy and adenotonsillectomy, parents counseling, weight loss and sleep hygiene. CONCLUSIONS. there is a gap between research on SDB in childhood and pediatric practice. © 2006 Associação Médica Brasileira.

A educação física adaptada no contexto da formação profissional: implicações curriculares para os cursos de educação física

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

DNA damage and antioxidant status in medical residents occupationally exposed to waste anesthetic gases

PURPOSE:To investigate the effects of occupational exposure to waste anesthetic gases on genetic material and antioxidant status in professionals during their medical residency. METHODS:The study group consisted of 15 medical residents from Anesthesiology and Surgery areas, of both genders, mainly exposed to isoflurane and to a lesser degree to sevoflurane and nitrous oxide; the control group consisted of 15 young adults not exposed to anesthetics. Blood samples were drawn from professionals during medical residency (eight, 16 and 22 months of exposure to waste anesthetic gases). DNA damage was evaluated by comet assay, and antioxidant defense was assessed by total thiols and the enzymes glutathione peroxidase (GPX), superoxide dismutase (SOD) and catalase (CAT). RESULTS:When comparing the two groups, DNA damage was significantly increased at all time points evaluated in the exposed group; plasma thiols increased at 22 months of exposure and GPX was higher at 16 and 22 months of exposure. CONCLUSION:Young professionals exposed to waste anesthetic gases in operating rooms without adequate scavenging system have increased DNA damage and changes in redox status during medical residency. There is a need to minimize exposure to inhalation anesthetics and to provide better work conditions.

Sal: uma abordagem sobre o elemento material na obra de arte

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Simulation-based ultrasound-guided central venous cannulation training program

PURPOSE: To propose a simulation-based ultrasound-guided central venous cannulation skills' training program, during residency.METHODS: This study describes the strategies for learning the ultrasound-guided central venous cannulation on low-fidelity bench models. The preparation of bench models, educational goals, processes of skill acquisition, feedback and evaluation methods were also outlined. The training program was based on key references to the subject.RESULTS: It was formulated a simulation-based ultrasound-guided central venous cannulation teaching program on low-fidelity bench models.CONCLUSION: A simulation-based inexpensive, low-stress, no-risk learning program on low-fidelity bench models was proposed to facilitate acquisition of ultrasound-guided central venous cannulation skills by residents-in-training before exposure to the living patient.

Time needed to schedule dermatological consultations in Brazil

BACKGROUND: It is not clear what the population's demand for dermatologists is, nor how many professionals are needed in order to provide adequate care in this area of expertise. Knowledge of the flow of patients at dermatological clinics throughout the country allows for the formation of expansion and distribution policies regarding professionals, and provides backing for the decision to increase medical residency places. OBJECTIVES: To evaluate the time it takes to schedule a private dermatological consultation in Brazil, and other factors concerning consultations. METHODS: Survey with a random sample of 14% of Brazilian dermatologists, simulating the scheduling of emergency clinical and cosmetic consultations, and botulinum toxin procedures. Also, details relating to cost and professionals, were studied. Data were adjusted for each region of the country. RESULTS: A total of 873 dermatologists were evaluated. Full SBD members represented 85%, and 66% were women. The median time to schedule a consultation ranged from 6 (out-of-pocket payment) to 7 (medical insurance) consecutive working days. Times varied depending on the region. A multivariate analysis showed that out-of-pocket consultations and procedures were scheduled sooner than with medical insurance, regardless of whether they were clinical or cosmetic. CONCLUSION: The characteristics of dermatologists are varied throughout regions of the country. Private consultations and procedures are scheduled sooner than with insurance companies.

Novelty of the arena impairs the cortisol-related increase in the aggression of matrinxa (Brycon amazonicus)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Obsessive-compulsive symptoms in medical students: prevalence, severity, and correlates

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

Preliminary report on the photo-identification of blue whales off Isla de Chiloé, Chile from 2004 to 2006

Photo identification of individual blue whales during summer and autumn off the northwestern Isla de Chiloé, southern Chile, were collected from marine surveys conducted from 2004 to 2006. Re-sightings of individual whales both within and between years may provide evidence of residency and site fidelity by blue whales in the area. These records further document the importance of the northwestern Isla de Chiloé as a feeding area for blue whales. These records also highlight the necessity of further comparisons with photographic catalogues from other areas in southern Chile, off the northwestern coast of South America and the Pacific coast of Central America to better understand seasonal movements, distribution of individuals along the eastern South Pacific, and their wintering areas.

SEASONAL, HABITAT AND SEX-SPECIFIC PATTERNS OF FOOD UTILIZATION BY RED-WINGED BLACKBIRDS (Agelaius phoeniceous) IN EASTERN ONTARIO AND THEIR ECONOMIC IMPORTANCE

Crop depredation by red-winged blackbirds (Agelaius phoeniceus) causes serious economic losses to agricultural crops each year in both Canada and the United States. The concentration of vulnerable, monocultural crops, particularly corn, during periods when large flocks of blackbirds congregate in roosting areas prior to migration has invariably led to heavy feeding pressure (Stone et al., 1972; Wiens and Dyer, 1975; Tyler et al., 1978). Efforts to reduce damage levels by mechanical and chemical dispersal agents have been largely unsuccessful, at least in terms of a long-term solution to the problem. Recently, the lethal control of blackbird populations using surfactants has been proposed. However, the potential repercussions of the removal of substantial numbers of birds from northern breeding areas are virtually unknown (Robertson et al., 1978). Much of the research dealing with the feeding ecology of red-winged blackbirds has been limited to fall and winter periods when large aggregations of birds are actively involved in crop depredation (Goddad, 1969; Williams, 1976; Dolbeer et al., 1978) or pose a potential health hazard (Monroe and Cronholm, 1976). However, what is not known is the degree to which the removal of deleterious weed seed and insect pests cited in several studies (Bird and Smith, 1964; Mott et al., 1972; Robertson et al., 1978) might be of potential value to agriculture. The issue of whether the benefits derived from redwing foraging compensate for the negative aspects associated with crop depredation and health hazards remains largely unresolved. The present study attempted to evaluate the pest status of this species using diet information derived from food habits analysis conducted during the residency of red- winged blackbirds in a northern breeding area. By determining how the feeding ecology of red-winged blackbirds varies on a seasonal basis, among different breeding habitats and between sexes, we hoped to determine more realistically which segments of the population might be responsible for the greatest benefits or detriments and, thereby, more accurately evaluate the economic impact of the species as a whole. To achieve this aim, the study provides an accurate description of the common insects and weed pests utilized by redwings. By determining the relative proportions of those items known to be detrimental, we hoped to illustrate, at least qualitatively, the degree to which redwing foraging is comprised of both beneficial and harmful components.

Utilização do questionário ERG na avaliação do grau de satisfação dos pacientes submetidos à otoplastia em um serviço de residência médica de otorrinolaringologia

A importância da intervenção cirúrgica em diminuir o sofrimento psicológico e melhorar a autoestima em pacientes com deformidades auriculares já está bem documentada. As pesquisas têm focado nos resultados das terapias com ênfase no paciente, observando principalmente satisfação, resultado funcional e impacto na qualidade de vida. Quantificar alterações na qualidade de vida tem sido um desafio. O uso de inquéritos válidos, a exemplo da Escala de Resultados de Glasgow (ERG), auxiliam na obtenção dos dados. OBJETIVO: Avaliar o impacto na qualidade de vida dos pacientes submetidos à otoplastia realizada em serviço de residência médica, utilizando como base a ERG, bem como sua funcionalidade. CASUÍSTICA E MÉTODOS: Estudo retrospectivo incluindo pacientes submetidos à otoplastia entre julho de 2009 e julho de 2010. Os dados foram coletados por meio de questionário oferecido ao paciente no retorno pós-operatório. RESULTADOS: Trinta e seis pacientes responderam ao questionário. Houve aumento na qualidade de vida, demonstrado pelas medianas positivas obtidas pelo questionário. Não houve diferença significativa quanto aos valores obtidos entre os sexos e entre diferentes faixas etárias. CONCLUSÃO: Os pacientes mostraram-se satisfeitos com o resultado pós-operatório. Houve aumento de qualidade de vida, conforme demonstrado pelos resultados positivos. A ERG pareceu-nos fácil e elucidativa.

Conhecimento médico sobre as imunodeficiências primárias na cidade de São Paulo, Brasil

OBJETIVO: Avaliar o conhecimento médico sobre as imunodeficiências primárias na cidade de São Paulo (SP). MÉTODOS: Um questionário de 14 questões sobre as imunodeficiências primárias foi aplicado a médicos que trabalhavam em hospitais gerais. Uma das questões apresentava 25 situações clínicas que poderiam ou não estar associadas às imunodeficiências primárias, e a porcentagem de respostas apropriadas gerou um indicador de conhecimento. RESULTADOS: Participaram do estudo 746 médicos, dentre os quais 215 pediatras (28,8%), 244 cirurgiões (32,7%) e 287 clínicos (38,5%). Cerca de 70% dos médicos responderam ter aprendido sobre as imunodeficiências primárias na graduação ou na residência médica. O atendimento a pacientes que usam antibióticos com frequência foi relatado por 75% dos médicos, mas apenas 34,1% já haviam investigado algum paciente e 77,8% não conheciam os dez sinais de alerta para as imunodeficiências primárias. O indicador de conhecimento obtido apresentou uma média de 45,72% (±17,87). Apenas 26,6% dos pediatras e 6,6% tanto dos clínicos quanto dos cirurgiões apresentaram indicador de conhecimento de pelo menos 67% (equivalente à resposta apropriada em dois terços das situações clínicas). CONCLUSÃO: Há uma deficiência no conhecimento médico das imunodeficiências primárias na cidade de São Paulo, mesmo entre os pediatras, a despeito do maior contato com o tema nos últimos anos. A melhora da informação sobre as imunodeficiências primárias entre a comunidade médica é um importante passo para o diagnóstico e o tratamento precoces dessas doenças.

High mobility rates during the period of the "Celtic migrations"? - 87 Sr, 86 Sr and delta 18 O evidence from Early La Tène Europe

Although the period of the historic “Celtic migrations” is archaeologically extensively studied, the long-lasting question whether mass migration or increased individual mobility caused the expansion of the La Tène culture throughout continental Europe persist. Strontium (Sr) and in part oxygen (O) isotope analysis of human remains from the early La Tène cemeteries of Nebringen (Germany), Münsingen-Rain (Switzerland), Monte Bibele (Italy) and the Czech cemeteries of Radovesice I, Radovesice II and Kutná Hora was, therefore, carried out to investigate the importance of residential changes during this time period. These isotope analyses showed that most analysed individuals either came from the area they were buried in or from the surrounding area of the cemetery. An exception was formed by the Czech cemeteries, where almost a quarter of the studied individuals appeared non-local. Together with Nebringen, these cemeteries also had the most varied Sr isotope ratios, which suggest highly mobile communities in which individuals regularly changed their residency. The isotopic ratios of the cemeteries of Münsingen-Rain and Monte Bibele appeared far less varied. In part, these differences might be explained by the community structures of these cemeteries. Morphological kinship analysis in Münsingen-Rain demonstrated biological relatedness among most of the analysed individuals. These related individuals also shared similar isotope signatures, which suggest an origin from the surrounding Aar Valley. In the vicinity of the cemetery of Monte Bibele, an associated settlement site was discovered. The deceased presumably not only shared this settlement, but also cultivated the same land plots. Dispersed settlement structures were suggested for Nebringen, Radovesice and Kutná Hora, as these agriculturally favourable landscapes were densely populated during prehistoric times. Connected to these community structures are the prevailing geological conditions in these areas. Both Münsingen-Rain and Monte Bibele are located in a region where homogeneous geological conditions prevail, whereas the landscapes of Nebringen, Radovesice and Kutná Hora are characterised by complex heterogeneous geological conditions. As the majority of individuals in Nebringen and the Czech cemeteries correspond to the expected isotope values for the studied areas, regularly changing land plots might have contributed to the observed variation. Although mass migration as depicted by the historical sources was not observed individual mobility of a small part of these studied communities certainly played a role. Males appeared, thereby, to have slightly more often a non-local birthplace or moved during childhood. Male mobility was, however, not always associated with burial as a warrior. Females, on the other hand, originated more often from the region. Patrilocal residential patterns, with the exception of the Czech cemeteries, were nevertheless not observed. Objects and ideas also seem to have been exchanged freely, as there are no indications that individuals with particular grave goods came from specific areas. It rather appears that the individuals buried with them were either local or had different places of origin. This can be explained by the fact that the exact origin of grave goods is difficult to establish and the occurrence of similar 87Sr/86Sr values in different areas. This study provided important new insights on the period of the “Celtic migrations” and the way of life of these prehistoric people.