I?ve never been told about that! : the teaching of sexualities from the perspective of undergraduates at a federal medical school.

Estudantes e profissionais de sa?de se mostram embara?ados ao se depararem com quest?es relativas ?s sexualidades de seus pacientes. Diante disso, n?o ? incomum o estabelecimento de uma rela??o superficial, erros no diagn?stico e a impossibilidade de condu??o do tratamento. Pesquisas indicam que essa dificuldade decorre de uma forma??o inadequada dos profissionais, especialmente no que diz respeito ao cuidado de grupos vulner?veis, cujas experi?ncias extrapolam os marcos heteronormativos hegem?nicos que delimitam o campo sexual. No Brasil, poucos estudos buscaram compreender como esse assunto ? tratado no ensino m?dico. Esta investiga??o se debru?ou sobre essa quest?o e teve como objetivo conhecer, na perspectiva de estudantes de uma escola federal de Medicina, como os aspectos relacionados ?s sexualidades e aos g?neros s?o abordados em suas gradua??es. Trata-se de uma pesquisa qualitativa em que foram realizadas entrevistas semiestruturadas com 15 estudantes do ?ltimo ano do curso. As falas foram gravadas, transcritas e examinadas por meio da an?lise de conte?do. O di?logo entre as categorias emp?ricas que se sedimentaram ao longo da investiga??o e a literatura revelaram dificuldades dos alunos em lidar com um tema que n?o pode ser completamente apreendido por um saber t?cnico e operacional. A ideia de que n?o se fala sobre o assunto no curso de Medicina contribui para velar o fato de que se fala (e se fala muito) sobre tais quest?es. A abordagem, no entanto, se d? por um vi?s organicista, que contribui para a manuten??o da cren?a em categorias bin?rias, naturalizadas e essencializadas, que refor?am as normas que regulam o campo da sexualidade. Apostando no protagonismo de todos aqueles envolvidos no ensino m?dico, discute-se, finalmente, a necessidade de altera??es qualitativas no curr?culo que possibilitem a constru??o de novas formas de conhecimento e de atua??o. Formas que, valorizando experi?ncias, saberes e pr?ticas pedag?gicas diversas, possam romper com as dicotomias e com as hierarquias hegem?nicas, transformando positivamente a realidade social.Health undergraduates and professionals feel embarrassment when facing issues concerning the sexuality of their patients. As a result, it is not uncommon to see the establishment of a superficial relationship, errors in diagnoses and the impossibility of giving treatment. Studies show that this difficulty is due to inadequate education of these professionals, especially regarding vulnerable groups whose experiences lie beyond the hegemonic heteronormativity which delimits the sexual field. In Brazil, there is limited research which aims to comprehend how this subject has been tackled in medical school. This investigation examined this issue and its main objective was to understand, from the perspectives of undergraduates at a federal medical school, how aspects regarding sexuality and gender are approached in the course. This is a qualitative research involving semi-structured interviews conducted with fifteen students in their final year of the course. The interviews were recorded, transcribed and examined based on content analysis. The subjects of the formal curriculum were also been analyzed, separating the titles of the classes which involved exclusively biological aspects from those which involved psychosocial aspects. Each one of these groups has been considered in relation to the total of content of the curriculum in order to assist us with the analysis of the interviews. The dialogue between the empirical categories and the bibliography shows the difficulty undergraduates feel in dealing with a theme that cannot be completely apprehended by technical and operational knowledge. The idea that the theme is not discussed in medical school contributes to hiding the fact that such a topic is, in reality, widely discussed. However, the approach used is organicist, contributing to the maintenance of binary, naturalized, essentialist categories which reinforce the norms that regulate the field of sexuality. Advocating the pivotal role that all individuals involved in medical education play, we finally discuss the need for qualitative changes in the curriculum which would enable us to build new forms of knowledge and performance. By valuing experiences, expertise and diverse pedagogical practices, these new forms can rupture the hegemonic dichotomies and hierarchies in order to positively transform social reality

Borderline personality features possibly related to cingulate and orbitofrontal cortices dysfunction due to schizencephaly.

Prefrontal cortex dysfunction has been associated with a series of behavioral symptoms, such as impulsivity and affective instability, which are the defining features of several personality disorders, notably, borderline personality disorder. We report on a 27-year-old patient with schizencephaly in the right frontal lobe (cingulate cortex lesion and secondary orbitofrontal cortex dysfunction) presenting with prominent borderline features and compromise of executive functions, decision-making and attention. We hypothesize that the personality disorder of our patient could be related to cingulate cortex lesion and secondary orbitofrontal cortex dysfunction associated with schizencephaly

Studies on elderly male excessive drinking: epidemiological and anthropological approaches

Submitted by Nuzia Santos ([email protected]) on 2019-08-08T17:32:38Z No. of bitstreams: 1 D_2005_HugoCanoPrais.pdf: 456967 bytes, checksum: 84cdec11bad3978b75cbb0cd412b84f5 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2019-08-08T17:44:26Z (GMT) No. of bitstreams: 1 D_2005_HugoCanoPrais.pdf: 456967 bytes, checksum: 84cdec11bad3978b75cbb0cd412b84f5 (MD5)Made available in DSpace on 2019-08-08T17:44:26Z (GMT). No. of bitstreams: 1 D_2005_HugoCanoPrais.pdf: 456967 bytes, checksum: 84cdec11bad3978b75cbb0cd412b84f5 (MD5) Previous issue date: 2005FINEP, CNPq e Ministério da Saúde.Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Belo Horizonte, MG, Brasil.Objetivos: Comparar as prevalências do consumo excessivo episódico de álcool entre homens idosos não institucionalizados e estudar as características sócio-demográficas, as condições de saúde e a rede de suporte social associadas a este tipo de consumo etílico. Métodos: O estudo baseou-se nos dados de dois inquéritos de saúde, ambos realizados no Estado de Minas Gerais. O primeiro refere-se à Região Metropolitana de Belo Horizonte (RMBH) (4.4 milhões de habitantes) e o segundo à cidade de Bambuí (15 mil habitantes). Selecionamos, randomicamente, 685 homens idosos (60+ anos) não institucionalizados da RMBH e em Bambuí todos os homens com 60+ anos participaram do estudo (N=641). Resultados: Encontramos as prevalências de 27% e 13,2% do beber excessivo episódico para a RMBH e Bambuí, respectivamente. Após ajustamentos para fatores de confusão, as seguintes variáveis permaneceram significativamente associadas ao beber excessivo episódico na RMBH: ser viúvo (OR=0,49), auto-avaliação da saúde como razoável (OR=0,38) e incapacidade para realizar pelo menos uma de cinco atividades de vida diária (OR=0,65) e ter 8 ou mais anos de escolaridade (OR=1,86). Os resultados encontrados para Bambuí foram: ser divorciado (OR=2,73), Autoavaliação da saúde como ruim/muito ruim (OR=0,30), ter consultado o médico 1-2 vezes no último ano (OR=1,82), não ter alguém com quem possa contar em momentos de necessidade (OR=2,22) e não ter recebido visitas dos filhos no último mês (OR=2,14). Conclusões: Discutimos algumas hipóteses que podem explicar a maior prevalência do beber excessivo episódico na RMBH, bem como a predominância dos fatores psicossociais associados ao beber excessivo episódico em Bambuí, enquanto na RMBH este esteve associado, dentre outros aspectos, à maior escolaridade e às limitações físicas.Aims: To compare the prevalence of binge drinking among community-dwelling older males, and to assess socio-demographic characteristics, health conditions and social network associated with it. Methods: The study was based on data from two health surveys carried out, both, in the State of Minas Gerais (SE-Brazil). The first survey was in a metropolitan area (Belo Horizonte Metropolitan Area: BHMA - 4.4 million of inhabitants) and the second one in Bambuí (15.000 inhabitants). In the BHMA, we randomly selected 685 communitydwelling older males (60+ yrs) and in Bambuí, all the males aged 60+ years were selected for the study (N=641). Results: Prevalence of binge drinking was 27% and 13.2% in the BHMA and Bambuí, respectively. After adjustments for confounders, variables significantly associated with binge drinking in the BHMA were: being widowed (OR=0.49), self rated health as reasonable (OR= 0.38), inability to perform at least one Activity of Daily Living (OR=0.65) and 8+ years of schooling (OR= 1.86). The results for Bambuí were: being divorced (OR=2.73), self rated health as bad/very bad (OR=0.30), 1-2 doctors’ visits the last year (OR=1.82), lack of someone present when needed (OR=2.22) and had received less than one visit of his children last month (OR=2.14). Conclusions: we discuss hypotheses that could explain the higher prevalence of binge drinking in the metropolitan area, as well as the predominance of psychosocial factors positively associated with binge drinking in Bambuí, while in the BHMA it was associated with the highest level of schooling

Melancholic features related to rimonabant.

Introduction: Obesity is currently considered a global epidemic and its prevention and treatment is a major public health concern, demanding treatment which may combine a sociocultural approach, lifestyle modification, nutritional, pharmacological or surgical strategies. Rimonabant, an endocannabinoid antagonist, has been proposed as an agent for an average weight loss of 4 kg. However, the development of anxiety and depressive symptoms can be major side effects. Case Report: A 27-year-old businessman, after using rimonabant (20 mg/day) for 1 month for weight loss, developed a major depressive episode with melancholic features, which remitted after the interruption of rimonabant. Discussion: To our knowledge, a major depressive episode with melancholic or atypical features specifier has not been described since the initiation of rimonabant pharmacological trials. The Hospital Anxiety and Depression Scale, used in the rimonabant trials, assesses several key points of depressive patients. However, it neglects the somatic symptoms that correspond to the additional criterion for both of the mentioned features as well as suicidal ideation. The severity of an episode could also be underestimated depending on the assessment tool or on the clinical interview. Conclusion: There may be an underestimation of depressive melancholic and atypical side effects related to Rimonabant use, due to the lack of consistent assessment with the appropriate screening tools. Pharmacological strategies should be adjunctive for obesity treatment when there is a failure in the lifestyle and nutritional modification strategies. Moreover, deeper global sociocultural changes should be made in the treatment and control of the global obesity epidemic

Working conditions and common mental disorders in physicians in Brazil.

Background Common mental disorders (CMD) are a marker of work-related psychiatric morbidity. Previous studies have shown a high prevalence in Brazilian health care settings. Aims To assess the prevalence of CMD and their associated factors in a group of physicians working at a public health unit in Belo Horizonte, Brazil. Methods CMD were evaluated using the Self-Reporting Questionnaire-20 (SQR-20), developed by the World Health Organization and validated for Brazil. The questionnaire consists of 20 questions: four about physical symptoms and 16 about emotional symptoms. Prevalence was calculated as a percentage of physicians with CMD. Poisson univariate and multivariate regression models were applied to assess associated factors. Results Analysis was based on 227 physicians who answered the SRQ-20 (97 % response rate). The preva-lence of CMD was 24%. Dissatisfaction and commitment to work remained positively associated with CMD. Having more than one job and significant social support from peers and superiors remained negatively associated with CMD. Conclusions Prevalence of CMD is in a similar range to that reported in other countries and in Brazil generally. Aspects related to work were the only ones that were independently associated with CMD. Work

Ziprasidone-related oculogyric crisis in an adult.

Introduction: Drug-induced dyskinesias arecommonside-effects of first-generation antipsychotics (FGAs) but are not usually related to second-generation antipsychotics (SGAs). Oculogyric crisis (OGC) is a disabling acute dystonia that affects extra-ocular muscles usually resulting in an upward deviation of the eyes, which lasts from minutes to hours. Case report:Wedescribe an adult patient, previously exposed to an FGA,whodevelopedOGCon 80 mg/day of ziprasidone. The movement disorder significantly improved after use of 1 mg/day of clonazepam without the need to switch to another SGA. Discussion: The clinical features of the movement disorder of our patient meet the criteria for OGC. It is, sometimes, difficult to directly correlate a drug-induced dyskinesia to a SGA due to previous exposures to FGAs. The onset of OGC after exposure to ziprasidone without simultaneous use of other antipsychotic suggests a casual relationship between the former and the movement disorder. It is possible that previous use of an FGA was a risk factor for the development of OGC. Conclusion: To the best of our knowledge, this is the first report of ziprasidone-related OGC in an adult patient. Physicians must be aware of its occurrence in order to improve care of patients treated with these agents

Estudo de base populacional sobre consumo excessivo de álcool entre homens idosos : evidências dos inquéritos de saúde de Belo Horizonte e Bambuí.

Objetivos: Determinar a prevalência e fatores associados ao consumo episódico excessivo de álcool em duas populações idosas (≥ 60 anos). Método: Foi selecionada uma amostra probabilística de 685 idosos na Região Metropolitana de Belo Horizonte e 642 (92,6% do total de residentes) idosos na cidade de Bambuí (15.000 habitantes), ambas situadas em Minas Gerais. A variável dependente do estudo foi consumo de ≥ 5 drinques em uma única ocasião nos últimos 30 dias e as variáveis independentes incluíram características sociodemográficas, rede social de apoio, condições de saúde e usos de serviços de saúde. Resultados: A prevalência deste consumo foi maior na Região Metropolitana de Belo Horizonte (27,0%) do que em Bambuí (13,7%). Na análise multivarida, pior percepção da saúde foi a única característica que persistiu associada ao consumo episódico excessivo de álcool em ambas as populações (RP = 0,62; IC95% 0,45-0,85 e 0,57; 0,40-0,83, respectivamente). Por outro lado, duas diferenças foram encontradas: 1) na Região Metropolitana de Belo Horizonte, o consumo excessivo de álcool apresentou associação significante com maior escolaridade [8+ anos] (RP = 1,55; IC95% 1,07-2,26) e com incapacidade funcional (PR = 0,12; IC 95% 0,02-0,83); 2) em Bambuí, observou-se associação independente entre esse consumo e ser divorciado ou separado (RP = 2,49; IC 95% 1,55-3,99). Conclusões: Os resultados mostram que diferenças na prevalência e fatores associados ao consumo episódico excessivo de álcool podem ser observadas entre populações de um mesmo país, provavelmente devido a influências socioculturais.Objectives: To assess the prevalence and factors associated with binge drinking in two populations of older adults (≥ 60 years). Method: A random sample of 685 subjects in the metropolitan area of Belo Horizonte (4.4 million inhabitants) and 643 subjects (92.7% from total residents) in Bambuí City (15,000 inhabitants), both in Southeast Brazil, participated in the study. The dependent variable was binge drinking (≥ 5 drinks on a single occasion in the last 30 days), and independent variables included sociodemographic characteristics, social network, health conditions and use of health services. Results: The prevalence of binge drinking was higher in the metropolitan area of Belo Horizonte (27.0%) than in Bambuí (13.7%). In the multivariate analysis, worse self-rated health was the only variable associated with binge drinking in both populations (Prevalence ratios [PR] 0.62; 95%CI 0.45-0.85 and 0.57; (0.40-0.83), respectively). On the other hand, two important differences were found: 1) in the metropolitan area of Belo Horizonte, binge drinking was associated with higher school level [8+ years] (PR = 1.55; 95%CI 1.07-2.26) and functional disability (PR = 0.12); 95%CI (0.02-0.83) 2) in Bambuí, binge drinking was associated with being divorced or separated (PR = 2.49; 95%CI 1.55-3.99). Conclusions: Among older adults, differences of prevalence and factors associated with binge drinking can be found in a same country, probably due to sociocultural influences

Um jogador patológico por Dostoiévski A pathological gambler by Dostoyevsky

O livro "O jogador" de Fiódor Dostoiévski narra um caso de jogo patológico bastante representativo. O percurso do personagem principal, Aleksei Ivanovitch, evidencia a dramática evolução do transtorno com três fases bem definidas: ganho, perdas e desespero. Partindo do conceito freudiano de narcisismo articulado aos conceitos da psicologia do self de Heinz Kohut, das teorias de Donald Winnicott e Wilfred Bion, serão discutidas as contribuições da psicanálise para a compreensão do jogo patológico.<br>Dostoyevsky's book, "The gambler," describes a representative case of pathological gambling. The history of the main character, Aleksei Ivanovitch, shows the typical evolution of the disorder in three well defined phases: profits, losses and despair. Based on Freud's concept of narcissism and the concepts of the self psychology by Heinz Kohut, Donald Winnicott and Wilfred Bion, the contributions of psychoanalysis to the understanding of pathological gambling are discussed