Oscarina da Silva Ezequiel

Evaluation of the acarofauna of the domiciliary ecosystem in Juiz de Fora, State of Minas Gerais, Brazil

From August 1999 to January 2000, samples of house dust were collected from 160 domiciles in the city of Juiz de Fora, State of Minas Gerais, Brazil. In 36 of these domiciles kitchen samples were obtained. Prevalence rate was 77.5%, varying according to the geographical sector. There were found 2,278 specimens of mites, with 1,530 (67.2%) in the adult stage and 748 (32.8%) in immature forms. The main species found were Dermatophagoides pteronyssinus, D. farinae, Euroglyphus maynei, Blomia tropicalis and Tyrophagus putrescentiae. In a minor incidence we found Lepidoglyphus destructor, Suidasia pontificiae, Chortoglyphus arcuatus, Cheyletus malaccensis, C. fortis, Ker bakeri, Cheletonella vespertilionis, C. caucasica and others. C. vespertilionis and C. caucasica were identified for the first time in the domiciliary ecosystem and in Brazil. The abundance rate and the infestation intensity were analyzed. There was a varied correlation between climatic conditions and positive domiciles and number of mites. The difference between the number of positive domiciles in the urban area and in the expanding urban area was significant and so was the difference between samples from the domiciles compared to those from the kitchens.

Prevalência dos atendimentos por crises de asma nos serviços públicos do Município de Juiz de Fora (MG)

OBJECTIVE: To evaluate the prevalence of asthma attacks treated in public health facilities in the city of Juiz de Fora, Brazil from February 1, 2002 to January 31, 2003. METHODS:This was a cross-sectional study involving monthly analyses performed in order to evaluate the asthma attacks treated. The variables analyzed were patient gender, age, and place of residence, as well as the profile of the visits by age bracket and by the site of the visit. In addition, we attempted to determine whether asthma attacks correlated with temperature or relative humidity. RESULTS: A total of 25,243 patients were treated for asthma attacks, accounting for 11.1% of the total number of visits to pediatric clinics and 2.7% of the total number visits to medical clinics. The mean age of the patients was 11.6 years (median, 4 years), and 52.9% of the patients were male. The analysis of the annual distribution revealed an increase in the number of asthma attacks treated in the months of May (11.5%), June (10.8%), and July (10.9%). Asthma attack presented a strong inverse correlation with temperature (-0.86) and a weak inverse correlation with relative humidity (-0.27). Statistically significant differences, in terms of mean age and gender, were found between patients with asthma attacks treated in emergency rooms and those treated in basic health clinics. The evaluation by age bracket revealed a predominance of males among patients younger than 12 years of age and a predominance of females among those aged 12 or older. CONCLUSION: We found that asthma represents a significant public health problem in this city. Local strategies are urgently needed in order to increase in the availability of prophylactic treatment.

Depression, stress and anxiety in medical students: A cross-sectional comparison between students from different semesters

OBJECTIVE To compare the prevalence of anxiety, depression, and stress in medical students from all semesters of a Brazilian medical school and assess their respective associated factors. METHOD A cross-sectional study of students from the twelve semesters of a Brazilian medical school was carried out. Students filled out a questionnaire including sociodemographics, religiosity (DUREL - Duke Religion Index), and mental health (DASS-21 - Depression, Anxiety, and Stress Scale). The students were compared for mental health variables (Chi-squared/ANOVA). Linear regression models were employed to assess factors associated with DASS-21 scores. RESULTS 761 (75.4%) students answered the questionnaire; 34.6% reported depressive symptomatology, 37.2% showed anxiety symptoms, and 47.1% stress symptoms. Significant differences were found for: anxiety - ANOVA: [F = 2.536, p=0.004] between first and tenth (p=0.048) and first and eleventh (p=0.025) semesters; depression - ANOVA: [F = 2.410, p=0.006] between first and second semesters (p=0.045); and stress - ANOVA: [F = 2.968, p=0.001] between seventh and twelfth (p=0.044), tenth and twelfth (p=0.011), and eleventh and twelfth (p=0.001) semesters. The following factors were associated with (a) stress: female gender, anxiety, and depression; (b) depression: female gender, intrinsic religiosity, anxiety, and stress; and (c) anxiety: course semester, depression, and stress. CONCLUSION Our findings revealed high levels of depression, anxiety, and stress symptoms in medical students, with marked differences among course semesters. Gender and religiosity appeared to influence the mental health of the medical students.

Effects of reviewing routine practices on learning outcomes in continuing education

Conventional continuing medical education (CME) has been shown to have modest effects on doctor performance. New educational approaches based on the review of routine practices have brought better results. Little is known about factors that affect the outcomes of these approaches, especially in middle‐income countries. This study aimed to investigate factors that influence the learning and quality of clinical performance in CME based on reflection upon experiences.

Manifestações dermatológicas desencadeadas por ácaros da família Cheyletidae: relato de caso

Cheyletidae mites are of great importance in the veterinary sciences, as they are associated with parasitism in birds and mammals. Yet they are barely studied as etiological factors to human dermatitis in spite of being referred to since the beginning of the 20th century. The authors propose to analyze a clinical case of dermatitis caused by mites of the Cheyletidae family in a six-month old patient. The discovery of three species of that family in the patients domiciliary ecosystem, associated to the cutaneous manifestations correlated with its definitive cure after this environment was sanitized, leads the authors to believe in the need to consider this diagnostic hypothesis for human dermatitis

Experiencing aging or demystifying myths? – impact of different “geriatrics and gerontology” teaching strategies in first year medical students

BackgroundWith the aging of the population comes a greater need for geriatric and gerontology teaching. However, there is currently a dearth of investigations on the impact of different educational methodologies for teaching in this area early in medical courses. The present study aims to determine the impact of two educational strategies on the topic “Geriatrics and Gerontology” (“experiencing aging” and “myths of aging”) as compared to a control group (no intervention) on the attitudes, empathy and knowledge of first year medical students.MethodsAn intervention-based study in education was conducted at the beginning of the first year of a medical course. Students submitted to educational strategies were compared against students with no intervention. The two strategies were: “Experiencing Aging” – also known as the “aging game” (simulation of the disabilities and physiological changes of aging), and “Myths of Aging” - a knowledge discussion based on a “quiz show”, questioning common myths about aging. All students were assessed on their attitudes towards older persons (Maxwell-Sullivan, UCLA attitudes), empathy (Maxwell-Sullivan), knowledge on facts and positive view about aging (Palmore), and cognitive knowledge. Data were analysed using Student’s t, Chi-squared or ANOVA tests.ResultsA total of 230 students were assessed. The “experiencing aging” intervention was associated with improvement in empathy but worsening of attitude. The “myths of aging” intervention was associated with an improved attitude overall and positive view about aging but with no change in empathy towards older persons.ConclusionEducational strategies can influence the attitudes and empathy of students, leading to different outcomes. These data highlight the importance of assessing the outcomes of educational strategies in medical teaching to ascertain in what manner (how), situations (when) and settings (where) these activities should be introduced.

Implementing an ‘Interprofessional fair’ for pre‐clinical medical undergraduates

What problem was addressed? There is an important gap in the medical curriculum worldwide: the lack of interprofessional education. Studies have shown that interprofessional learning can improve attitudes towards and knowledge of collaborative practices. However, in Brazil there is still a fragmented view of health practice, particularly in the pre-clinical years. In our medical school, some students enter clerkship without knowing the core competencies of each health profession and without being exposed to other health professionals. Because one of the most important interprofessional competencies is role clarification, this activity aimed to create an opportunity to develop an understanding of role clarification in medical students. What was tried? A Brazilian medical school established an initiative to increase the contact of medical students with other health professionals (HPs) in the third year during a mandatory geriatric medicine course in 2015. The initiative, entitled ‘Interprofessional Fair’, aimed to create a hands-on environment associated with a group competition, providing information and practical activities about different professions. Students (80 students in the class) were divided into five groups and went through all five stations (physiotherapy, pharmacy, psychology, physical education and phonoaudiology). Each station lasted 20 minutes and had different activities aiming to show the core competencies of HPs’ work with older adults; for instance, participating in physical activities designed for the aged, memory activities, experimenting with respiratory therapy devices, separating medication capsules and dysphagia treatment exercises, among others. In order to motivate the students, there was a competition, in which the groups completed a crossword puzzle that included what they had learned; the group with the most correct answers was rewarded with chocolate candy. At the conclusion, all students received a sheet with the role of each profession in geriatric care and completed a feedback questionnaire including the final grade they gave to the activity (0 to 10) and their opinions (Likert 1 = strongly disagree to 5 = strongly agree) concerning the content, objectives and implications for their practice of this activity. What lessons were learned? Seventy-seven students took part in this activity. Students agreed or strongly agreed that: the content was important for their future work as a physician (94.8%), the class objectives were clear (97.4%), the activity stimulated their learning (93.5%), the level of difficulty was appropriate (92.2%), they could use this content in their daily activities (94.8%), the type of activity helped to learn the content (92.2%) and the class was useful (92.2%). The final grade given by students to the activity was 9.11 (SD, 1.02). At the end of the semester, there was a multiple-choice question concerning interprofessional care included in their final test for the course and all students but one answered correctly. These results support the belief that an interprofessional intervention for large groups could provide motivation, satisfaction and knowledge acquisition in pre-clinical medical students, enhancing their proximity to other health professionals and allowing them to fully understand each competency in the health care system, highlighting the role of activity learning and innovations in oversaturated medical curricula.

Cross-cultural Differences in Mental Health, Quality of Life, Empathy, and Burnout between US and Brazilian Medical Students.

ObjectiveThis study aimed to compare mental health, quality of life, empathy, and burnout in medical students from a medical institution in the USA and another one in Brazil.MethodsThis cross-cultural study included students enrolled in the first and second years of their undergraduate medical training. We evaluated depression, anxiety, and stress (DASS 21), empathy, openness to spirituality, and wellness (ESWIM), burnout (Oldenburg), and quality of life (WHOQOL-Bref) and compared them between schools.ResultsA total of 138 Brazilian and 73 US medical students were included. The comparison between all US medical students and all Brazilian medical students revealed that Brazilians reported more depression and stress and US students reported greater wellness, less exhaustion, and greater environmental quality of life. In order to address a possible response bias favoring respondents with better mental health, we also compared all US medical students with the 50% of Brazilian medical students who reported better mental health. In this comparison, we found Brazilian medical students had higher physical quality of life and US students again reported greater environmental quality of life. Cultural, social, infrastructural, and curricular differences were compared between institutions. Some noted differences were that students at the US institution were older and were exposed to smaller class sizes, earlier patient encounters, problem-based learning, and psychological support.ConclusionWe found important differences between Brazilian and US medical students, particularly in mental health and wellness. These findings could be explained by a complex interaction between several factors, highlighting the importance of considering cultural and school-level influences on well-being.

Geographical distribution of medical graduates from a public university

Objective: To evaluate the geographic distribution and career trajectory of medical graduates and the factors associated with their choice of practice location. Method: A cross-sectional study involving graduates from December 2001 to December 2010 was conducted. A self-administered questionnaire collected demographics and geographic information (place of birth, place of residence at the time of medical school admission, place of residency training and practice location), and reason for choosing the current location. Statistical analyses assessed trends in geographic distribution of graduates, and identified factors associated with location choice (through the population density of the location chosen for professional practice). Results: A total of 563 graduates completed the questionnaire. Of those, 4.3% (n=24) reported family medicine as their medical specialty, 19.9% (n=112) reported other primary care specialties (internal medicine, pediatrics, surgery and obstetrics-gynecology) and the others chose subspecialties. Larger cities were more likely to be chosen for practice, particularly for newly-graduated doctors. Job invitations received during medical residency training increased the likelihood of choosing high-populated cities. In contrast, job invitations received during medical school increased the likelihood of choosing cities less populated. Amongst those in cities with lower population density, proximity to family members was an additional influencing factor; those who chose more densely populated cities did so because of better infrastructure and recreational options. Conclusion: Most of the physicians included in this study pursue subspecialties training and were practicing medicine in large cities. Knowing the multiple factors that influenced the choice of practice location can assist in planning future strategies to reduce physician workforce misdistribution.

An OSCE with very limited resources: Is it possible?

We have read with great interest the article by Abdelaziz et al. (2016) concerning the development of an OSCE with limited resources and we acknowledge the challenges of conducting it at low costs. In support of their findings, we would like to share our own experience in a Brazilian medical school. In Brazil, there is currently an economic crisis, which is partially responsible for a lack of funding from the government to the federal institutions. Therefore, some incomes were drastically reduced, including those for paying complex assessments (e.g. OSCE). In view of this problem, we had two options: stop with OSCEs or create a low-cost OSCE. We have chosen the second option and decided to create strategies for the implementation of this new low-cost OSCE. In our medical school, the OSCE is performed each semester for all 90 students participating in the 5th-year clerkship and the Medical Education department staff perform the organization. Due to the financial restraint, we opted for a three-station mini-OSCE with a 12-student rotation each time, which lasted for 3 hours. Concerning the human resources, we invited the medical school faculty as assessors and the PhD students from the Post-graduation program as Standardized patients and as facilitators. The venue used was the medical school building, which has its classrooms in a U-shape format and the equipment were obtained by different sources: the mannequins from the clinical skills laboratory, furniture from the own building, instead of an alarm bell or digital announcement we used a whistle, all communication between organizers were carried out through ‘‘camping’’ walkie-talkies, papers (checklists, forms) were printed by the medical school, video documentation was performed using tablets (provided by the organizers and by faculty members), gloves and masks (through faculty donation) and catering – beverages and cookies (through faculty donation). The total cost of the OSCE was R