Maria José Pereira Vilar

Prevalência de transtornos mentais comuns e avaliação da qualidade de vida no climatério

OBJECTIVE: To evaluate prevalence of mental distress and health-related quality of life (HRQoL) in climacteric women. METHODS: A total of 191 women (45 to 65 years of age) were included in this cross-sectional study. A questionnaire about personal information, habits/health, and demographic data was administered in association with the two validated instruments to measure HRQoL, SF-36, Medical Outcomes Study 36-item Short-Form Health Survey and to estimate prevalence of common mental distress (20-item SRQ, Self Reporting Questionnaire). RESULTS: By using the 20-item SRQ for assessing mental distress, and establishing a cut-off level of at least 8 items, 39.8% of the women were categorized as having mental distress. A higher prevalence of mental distress and lower SF-36 scores were found in women in the perimenopause, particularly those with poor education and low family income who did not work outside the home. All SF-36 domains were significantly lower in women with mental distress than those in women without mental distress. CONCLUSION: Prevalence of mental distress is high in this sample of climacteric women and is associated with negative repercussions on the quality of life. This shows that psychosocial factors are significantly involved and psychological support strategies should be instituted in the form of health policies for climacteric women.

Lúpus eritematoso sistêmico (LES): perfil clínico-laboratorial dos pacientes do Hospital Universitário Onofre Lopes (UFRN-Natal/Brasil) e índice de dano nos pacientes com diagnóstico recente

OBJETIVO: Determinar a frequencia das manifestacoes clinicas e laboratoriais de pacientes com lupus eritematoso sistemico (LES) e identificar os danos precoces nos pacientes com diagnostico recente. METODOS: Avaliacao retrospectiva de 164 pacientes com LES do ambulatorio de Reumatologia do Hospital Universitario Onofre Lopes - UFRN, de abril de 2003 a dezembro de 2004. As manifestacoes clinicas e laboratoriais avaliadas referem-se aos criterios de classificacao do Colegio Americano de Reumatologia. A avaliacao do indice de dano, atraves do SLICC/ACR DI (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) foi realizada em 32 pacientes que tinham entre dois e tres anos de diagnostico. RESULTADOS: As manifestacoes clinicas mais frequentes foram as cutâneas (90,2%), em especial a fotossensibilidade. As demais manifestacoes clinicas e laboratoriais foram semelhantes as descritas na literatura. Dano orgânico precoce foi identificado em nove pacientes com doenca recente (28,1%) e, novamente, o acometimento cutâneo foi o mais frequente (12,5%). CONCLUSAO: Tanto as manifestacoes clinicas quanto os danos orgânicos precoces mais comuns foram relacionados a pele. Portanto, faz-se necessario o incentivo a fotoprotecao em nossa regiao, que tem alta influencia dos raios ultravioleta.

Metabolic syndrome in systemic lupus erythematosus: lower prevalence in Brazil than in the USA

We read with great interest the recent article by Chung et al on the high prevalence of metabolic syndrome (MetS) in patients with systemic lupus erythematosus (SLE).1 This topic is extremely relevant as regards the current clinical management of patients with SLE, since findings from several studies point to increased cardiovascular risk associated with this disease.2–4 As with most previous research on the incidence of MetS, this study was conducted in the American population where the prevalence of obesity is higher than in other countries.1 However, it is very important to consider the results from studies conducted in different populations when analysing the influence of obesity and other …

Surgical site infection in a university hospital in northeast Brazil

We examined prevention of surgical site infection (SSI) in a tertiary teaching hospital in northeast Brazil, from January 1994 to December 2003. The survey included 5,742 patients subjected to thoracic, urologic, vascular and general surgery. The criteria for diagnosing SSI were those of the Centers for Disease Control, USA, and the variables of the National Nosocomial Infection Surveillance risk index were used. Data analysis revealed that anesthetic risk scores, wound class and duration of surgery were significantly associated with SSI. A total of 296 SSIs were detected among the 5,742 patients (5.1%). The overall incidence of SSI was 8.8% in 1994; it decreased to 3.3% in 2003. In conclusion, the use of educational strategies, based on guidelines for SSI prevention reduced SSI incidence. Appropriate management of preoperative, intraoperative, and postoperative incision care, and a surveillance system based on international criteria, were useful in reducing SSI rates in our hospital.

A humanização e a formação médica na perspectiva dos estudantes de medicina da UFRN - Natal - RN - Brasil

This study used a qualitative approach to understand the perspective of medical students at the Federal University in Rio Grande do Norte, Brazil, concerning humanization in the context of medical training. A focus group technique was used, involving a multidisciplinary team from anthropology, psychology, and medicine that studied two groups of nine students each from the last year of medical school. Data were submitted to categorical thematic content analysis, revealing three categories: the student-patient, teaching-learning, and student-professor relationships. The first category showed that the students experience of contact with patients is essential for constructing a humanized professional identity. In the second category, professors with no training in inherent pedagogical practices, plus the dichotomy between theory and practice, hinder the autonomous formation of knowledge and a comprehensive view of the individual. Two opposing sub-categories emerged from the third category (model professor and asymmetric relations) that reflect the importance of the professors ethical-humanist stance rather than an authoritarian attitude in the construction of the students professional identity. These data highlight aspects of medical training that can substantiate a discussion of humanization in the context of the new curricular guidelines.

Processo de significação de estudantes do curso de medicina diante da escolha profissional e das experiências vividas no cotidiano acadêmico

The purpose of this study is to perform an extensive analysis of career-choice motivations of medical students at the Federal University of Rio Grande do Norte, Natal, Brazil, and to understand their daily academic experiences. The methodology employed was qualitative, using semi-structured interviews. The sample consisted of 30 students from the 1st to the 6th year of the course, uniformly selected from the different course levels. The data were analyzed by means of content analysis. This analysis revealed that factors that influenced the students in the choice of the medicine course were family influence, personal identification, the search for financial independence and professional status as well as the desire to help and to be useful. In relation to moments experienced during the course, the recognition of family and friends, experiences with patients and contact with competent professors were cited as the most gratifying, while extensive examinations and insufficient time for studying, uninspiring classes given by outdated professors, contact with terminal patients and death along with physical exhaustion were considere the most distressing moments. The data point to important aspects in the daily life of medical students that may help to determine psycho-pedagogic support strategies in future curricular guidelines.

Interprofessional education as an approach for reforming health professions education in Brazil: emerging findings

Abstract Interprofessional education (IPE) is an important issue to insert in the debate on the reform of the education of health professions in Brazil. This paper provides details on an emerging study, based in Brazil, whose aim is to explore the use of IPE as a strategy to reform health professional education to become more collaborative in nature. The study has adopted a sequential mixed-methods approach, and will conduct focus groups, individual interviews and surveys with students, teachers and administrators based in two universities. Initial findings have indicated that, at present, participants were not aware of systematic strategies to bring students from different courses together for IPE, which has created problems for the development of knowledge and skills for collaborative work. Further data will be gathered to expand this analysis. Nevertheless, there is already clear evidence that there is a need to integrate and strengthen the use of IPE in Brazil, as a key route forward to strengthening the process of reorientation training of health professionals.

Incidência de lúpus eritematoso sistêmico em Natal, RN - Brasil

OBJETIVO: estudar a incidencia de lupus eritematoso sistemico (LES) na cidade de Natal, RN, Brasil. METODOS: foram incluidos somente pacientes residentes em Natal, RN, com idade > 15 anos, com pelo menos, quatro criterios do ACR, entre 1/1/ 2000 e 31/12/2000, excluindo lupus droga-induzido. Foram utilizadas quatro fontes para identificacao de pacientes: 1) hospital universitario; 2) postos de saude de hospitais da rede publica; 3) especialistas (reumatologistas, dermatologistas, nefrologistas e hematologistas) em clinicas e hospitais privados e 4) resultados positivos de FAN (> 1:80) de tres principais laboratorios da cidade. Medicos foram informados, por cartas, dos procedimentos para notificacao. Dados do Censo 2000 foram utilizados para o calculo das taxas de incidencia. Standardized Mortality Ratio (SMR) foi aplicado para comparacao das taxas de incidencia. O valor de p < 0,05 foi considerado significativo. RESULTADOS: foram identificados 43 novos casos de LES, com uma incidencia calculada de 8,7 por 100.000/ano (95% IC 6,3-11,7/100.000). Trinta e oito mulheres 14,1:100.000/ano (95% IC 10,0-19,3) e 5 homens 2,2 por 100.000/ano (95% IC 0,7-5,2). A media de idade dos pacientes foi de 31,8 anos (95% IC 27,8-35,8), sendo de 31,4 anos (95% CI 27,2-34,7) nas mulheres e de 35 anos (95% CI 27,8-52,2) nos homens. A mediana de duracao da doenca (tempo entre a primeira manifestacao clinica de LES e o diagnostico ) foi de 10 meses (1 a 72 meses). CONCLUSOES: a incidencia de LES em Natal, RN, parece ser maior que a relatada em outras regioes do mundo. Fatores etnicos e ambientais, como maior exposicao a radiacao ultravioleta, parecem contribuir para essas diferencas observadas.

Condutas usuais entre os reumatologistas brasileiros: levantamento nacional

OBJECTIVE: Evaluate routine clinical practices of Brazilian rheumatologists. METHOD: Virtual clinical scenarios representing a range of rheumatological practical situations were sent by mail to 831 specialists certified by the Brazilian Society of Rheumatology (SBR) with postage-paid envelopes for reply. RESULTS: Only 21.4% of the questionnaires were returned. The average age of responding rheumatologists was 42.7 years (SD=11.7), with an average time since graduation from medical school of 19.8 years (SD=10.1). In a clinical scenario describing early active rheumatoid arthritis most respondents (84.7%) chose to initiate treatment with prednisone or prednisolone. The most chosen disease modifying antirheumatic drugs were methotrexate (84,2%) and chloroquine (63.8%). Four rheumatologists (2.8%) indicated biological agents (infliximab and etanercept) as their initial choice of treatment. Prophylaxis for corticoid-induced osteoporosis and calcium and vitamin D supplementation were recommended by only 61.2% and 46.5% of the respondents, respectively. In a clinical scenario describing systemic lupus erythematosus, almost all doctors prescribed oral corticoids (93.7%), chloroquine (92.5%) and photoprotection (93.7%). In the presence of lupus nephritis with unimpaired renal function and normal blood pressure levels, the most frequently adopted management was pulse therapy with corticoids (47.7%) or high doses of oral prednisone. Pulsetherapy with cyclophosphamide was indicated by 34.6% of the respondents. In a clinical scenario describing acute mechanical back pain without alarming signs, 55.4% stated that they would request no laboratory examinations on the first encounter and the main treatments of choice were non-hormonal antiinflammatory drugs (89.3%), muscle relaxant drugs (72.9%) and physical therapy (33.3%). Bed rest was recommended by 31.6% of the respondents. In a clinical scenario describing chronic back pain with recent X-ray showing first degree spondylolisthesis and disc arthrosis, 39.6% of the rheumatologists stated that they would not request additional examinations, while 26.2% and 24.4% would request computer tomography scans and magnetic resonance scans, respectively. The most frequently prescribed treatments were physical therapy (75.1%), muscle relaxant drugs (48.5%), RPG (45.6%), physical exercise (41%), Cox-2-selective non-hormonal antiinflammatory drugs (40.5%), amitriptyline (35.3%) and opioid analgesics (34.7%). The questionnaire also included scenarios describing knee arthrosis and shoulder pain. CONCLUSION: The low rate of response from rheumatologists may be associated with aspects of Brazilian culture. In fact, respondents displayed a very similar profile throughout the country. Most of the prescribed treatments agree with available evidence and reflect a homogeneous approach to rheumatological disease among professionals. However, although the present study has provided interesting information regarding clinical practices, the small number of respondents may not be particularly representative of the population of Brazilian rheumatologists.

Educação médica e integralidade: o real desafio para a profissão médica

1. Professor Doutor do Departamento de Morfologia, Disciplina de Anatomia Humana e Membro do Nucleo de Educacao Medica da Universidade Federal do Rio Grande do Norte (UFRN).2. Professora Doutora do Departamento de Medicina Clinica, Disciplina de Reumatologia e Membro do Nucleo de Educacao Medica da UFRN.