Revista da Associa??o Médica Brasileira (English Edition)最新文献

Objective

This paper proposes the unification of entrance exams to medical residency programs (MRP) in Brazil. Problems related to MRP and its interface with public health problems in Brazil are highlighted and how this proposal is able to help solving these problems.

Methods

The proposal is to create a database to be applied in MRP unified exams. Some advantages of using the Item Response Theory (IRT) in this database are highlighted.

Results

The MRP entrance exams are developed and applied decentralized where each school is responsible for its examination. These exams quality are questionable. Reviews about items quality, validity and reliability of appliances are not common disclosed.

Conclusion

Evaluation is important in every education system bringing on required changes and control of teaching and learning. The proposal of MRP entrance exams unification, besides offering high quality exams to institutions participants, could be as an extra source to rate medical school and cause improvements, provide studies with a database and allow a regional mobility.

Objective

To evaluate the completion of medical death certifications in Belém, state of Pará, Brazil in 2010.

Methods

In the present study, 800 medical certifications of non-violent death, randomly chosen, and produced in 2010 were analyzed. Regarding correct completion, all fields of the document were evaluated, except for fields I (reserved for civil registries), V (stillbirth or death under age of 1 year), and VIII (external causes/violent death). Each field was analyzed regarding the following parameters: incomplete fields, fields left blank, illegibility, and incorrect completions.

Results

Based on the data collected, very high rates of errors in completion were observed; 98.7% of the certifications had at least one mistake. The most remarkable and important mistakes were found in field VI, intended for the cause of death, with a frequency of error of 71.5%, especially due to vagueness.

Conclusion

The very high rates of poorly completed medical death certifications highlights a significant failure in the medical schools’ curriculum, as well as a lack of continuing medical education programs addressing such topic of paramount importance. The results demonstrated neglect or lack of knowledge on the pathophysiology of diseases by physicians.

The aim of this study was to identify publications in literature that investigated Homocys-teine (He) as a risk factor for CVD among children and adolescents. An active search for information in LILACS, IBECS, Science Direct, Medline and Cochrane Library databases was conducted using the following combination of keywords “homocysteine”, “cardiovascular diseases”, “child” and “adolescent”. Fifteen articles were analyzed showing direct relationship with increasing age (8 studies) and male gender (10 studies), and an inverse relationship with serum vitamins B6, B12 and folate levels. Thus, the results suggest that more research must be carried through in order to determine in a more coherent way the causes of the hiperhomocisteinemia in the pediatric population, guiding for an adequate diet, rich in nutrients necessary to favor the metabolism of the He.

Objective

To investigate the impressions made by different styles of dress and appearance adopted by physicians on patients, medical students, and other physicians in Brazil.

Methods

Two hundred fifty nine patients, 119 students, and 99 physicians answered questions related to a panel of male and female physicians’ pictures covering the following styles: white clothing; white coat; formal coat; formal, informal, and casual garments; and surgical scrubs. They also reported their level of discomfort with a list of 20 items for professional appearance of both genders.

Results

Most of the answers of the volunteers involved using white clothes or white coat, and in many situations the percentages of preference referred for these styles were close. Physicians and students preferred physicians wearing surgical scrubs for emergency visits, and doctors with informal style for discussing psychological problems with male professionals. Patients most often chose white clothing in response to questions. Regarding male professionals, all three groups reported a high degree of discomfort for the use of shorts and bermuda shorts, multiple rings, facial piercings, sandals, extravagant hair color, long hair, and earrings. For females, high levels of discomfort were reported for shorts, blouses exposing the belly, facial piercings, multiple rings, extravagant hair color, and heavy makeup.

Conclusion

Brazilian patients, physicians, and medical students form a better initial impression of physicians using clothing traditionally associated with the profession and exhibiting a more conventional appearance. The use of entirely white garments appears to be a satisfactory option in this country.

Recent years have witnessed a substantial increase in the number of seric determinations of vitamin D, in a worldwide basis. At Hospital das Clínicas of Faculdade de Medicina of Universidade de São Paulo that increase reached 700% over the last four years. Nevertheless there are many controversies on the literature about the role of vitamin D in conditions unrelated to the musculoskeletal system. In this study the metabolism, sources and actions of vitamin D on the body are reviewed. Observational studies, clinical trials, systematic reviews and metanalysis which focused on the relationship between the vitamin and conditions such as cancer, cardiovascular disease, diabetes and falls were searched on the literature, analyzed and discussed. Results are presented as quiz and answer, tables and a figure. The role of vitamin D on the above-mentioned conditions is discussed, and the controversial issues stressed.

Objective

To verify factors associated with nutritional status in an oldest elderly community-dwelling population in Southern Brazil.

Methods

This cross-sectional epidemiological and household-based study involved all subjects (n = 134) aged ≥ 80 years who were living in Antônio Carlos (Santa Catarina state, Brazil). Nutritional status was assessed by body mass index (BMI < 22.0 kg/m², underweight; BMI > 27.0 kg/m², overweight). Explanatory variables in the study were: gender (women/men), literacy (knows how to write and read – yes/no), living conditions (lives alone/with company), cognitive function (normal/altered), eating difficulty (yes/no), medication use (none to two/three or more), morbidity (none to two/three or more diseases), alimentary pattern (adequate/inadequate), alcohol consumption (none to one day a week, two or more days a week), cigarette smoking (never/current or former smoker), physical activity level (< 150 min/week; ≥ 150 min/week), and sitting time (< 4 hours/day; ≥ 4 hours but < 6 hours/day; ≥ 6 hours/day).

Results

Prevalence of underweight was 27.3% in men and 12.8% in women (p < 0.01), and was positively associated with altered cognitive function (OR: 3.52) and inversely related with greater medication use (OR: 0.34). Overweight affected 25.5% of men and 53.8% of women. It was negatively associated with illiteracy (OR: 0.12) and positively associated with female gender (OR: 2.58).

Conclusion

There are differences between men and women regarding nutritional status. The factors associated to nutritional status of the oldest elderly from Antônio Carlos are specific to the vulnerability condition (underweight and overweight).

Objective

To compare the frequency of cardiovascular risk factors (CVRFs) in obese patients of the Brazilian Unified Health System (Sistema Único de Saúde – SUS) with indication of bariatric surgery during the preoperative period and after the sixth month and the first year of the procedure.

Methods

An observational, longitudinal, prospective, and analytical study was performed, with consecutive selection of obese patients with indication for surgery referred to preoperative cardiac evaluation. The protocol consisted of: medical history, physical examination, electrocardiogram, echocardiogram, and biochemical analysis. This study analyzed the following variables: weight, body mass index (BMI), waist circumference (WC), systemic arterial hypertension (SAH), diabetes mellitus type 2(DM), dyslipidemia (high LDL cholesterol; low HDL cholesterol; hypertriglyceridemia), and metabolic syndrome (MS). The chi-squared test and the Tukey-Kramer method were used for statistical analysis.

Results

The sample was composed of 96 obese people, among which 86 were women, aged between 18 and 58 years old (median 35 years old). At the end of six months, significant reductions of 88%, 95%, 71%, 89%, and 80% in the frequency of SAH, high LDL cholesterol, hypertriglyceridemia, DM, and MS could already be observed. A significant and small reduction in the frequency of low HDL cholesterol (24%) and abnormal WC (31%) was observed only at the end of 12 months. After six months and one year, weight and BMI experienced reductions of 33.4 kg and 44.3 kg, and 13.1 kg/m² and 17.2 kg/m², respectively.

Conclusion

The positive impact on weight loss and the reduction in BMI, WC, and in the frequency of CVRFs are already extremely significant after six months and remain so one year after bariatric surgery.

Objective

This study aimed to review the congenital malformation known as agenesis of the dorsal pancreas (ADP) and other pancreatic birth defects, based on a rare and exemplary clinical case of pancreatic malformations. The intent was to review the latest information published in the national and international literature on pancreatic birth defects, and to investigate the diversity of clinical presentations of ADP and other congenital pancreas abnormalities. The purpose was to identify which situations have therapeutic indication, the most appropriate time to institute treatment, and the currently available medical or surgical treatment of pancreatic congenital malformations.

Results

ADP is a very rare malformation that occurs during organogenesis. In the last decades, a large volume of embryological and genetic information has been obtained, helping to understand the causes of pancreatic malformations, which must be studied and understood as a whole.

Conclusion

Pancreatic malformations are infrequently studied causes of acute and chronic pancreatitis in adults. The possibility of pancreatic malformations should always be considered in patients with acute or chronic pancreatitis with no evident cause.