Impacto da desnutrição na qualidade de vida de pacientes com cirrose hepática

Liver cirrhosis is associated with high morbidity and mortality, impairment of quality of life (QOF) and malnutrition. This study assessed the impact of malnutrition on QOF of hospitalized cirrhotic patients. The instruments used were Nutritional Subjective Global Assessment (SGA) and Quality of Life Short Form (SF-36). Ninety two patients were included. Malnutrition was quite prevalent and QOF in all its domains was impaired, specially the role-physical domain. Malnutrition was associated with lower QOF in physical and emotional aspects domains. Early diagnostic approach can provide valuable information for the better nutritional and psychological management of patients, given the need for greater humanization in the treatment of the physical and emotional suffering of these patients

Análise do padrão de consumo de álcool em usuários da Unidade Básica de Saúde Santo Antônio em São José do Rio Preto.

Introdução: o uso nocivo do álcool é um dos fatores de risco de maior impacto em todo o mundo. Segundo pesquisas nacionais, 12%da população brasileira é dependente de álcool, representando uma parcela significativa da população atingida por esta problemáticaque é um dos mais graves problemas de saúde pública. Objetivo: identificar o padrão de consumo de álcool entre usuários de umserviço de Atenção Primária à Saúde. Metodologia: estudo descritivo com pacientes da Unidade Básica de Saúde (UBS) Santo Antônioem São José do Rio Preto, São Paulo, através de aplicação de questionário AUDIT (Alcohol Use Disorders Identification Test) que foidesenvolvido para rastrear o uso excessivo de álcool e quantificar o consumo e sintomas de dependência do alcoolismo. Foram incluídospacientes com idade maior ou igual a 18 anos e que aceitaram participar da pesquisa, assinando o Termo de Consentimento Livre eEsclarecido. Resultados: no total, 163 participantes foram incluídos no estudo e os padrões de consumo encontrados foram: 44,4%dos pacientes em zona I (baixo risco); 25,3% em zona II, 9,3% em zona III e 21% em zona IV. Conclusão: foi encontrada uma parcelapreocupante de pacientes com índice de uso nocivo e dependência de álcool entre pacientes de uma UBS no noroeste de São Paulo.Este índice foi superior à média nacional. Estes dados serão divulgados junto às autoridades competentes, visando estimular ainda maisa implantação de medidas que visem prevenção e promoção da saúde, quanto ao uso nocivo de bebidas alcoólicas junto à sociedad

Witnessing death does not necessarily relieve the dis-comfort of death: analysis of the relationship between religiosity and thanatophobia in medicine undergraduate students

Introduction: It is known that very few issues related to death and religiosity/spirituality are addressed during medical graduation. Understanding the process of death and dying is still a problem for medical students before the terminal condition of a patient. Probably the medical students of the fifth graders overestimate their abilities, probably because they have not yet had contact with terminally ill patients or because they have not graduated, they do not take responsibility for the death of a patient they are following. In Brazil, many students believe that the topic of spirituality influences health, but they do not feel prepared to address this issue with patients. Objective: It was to analyze whether there is a relationship between religiosity and thanatophobia in medical students. It also analyzed whether there was a correlation between fear of death and specific religions, sex and age, and the index of religiosity with sex and age. Methods: Followed a prospective observational cross-sectional model, following the STROBE clinical research rules. This study was analyzed and approved by the Research Ethics Committee (CEP) according to a substantiated opinion number 2,031,705, and obtaining the patient's consent. Results: A total of 542 students (61.2% of the total) answered the questionnaire. Most were female (65.7%) and with a mean age of 22.31 (ranging from 17 to 39 years). The majority of students have a religion (90.1%) and 90.4% considered it important to address the issue of death and religiousness during graduation. In this study, it was observed that most students, in addition to having some kind of religion, consider it important to address the themes highlighted during the course. This was similar to the findings in other studies. There was no statistically significant relationship between having a religion and being less afraid of death. However, students with higher levels of intrinsic religiosity showed greater discomfort when dealing with terminal patients. Furthermore, no studies comparing these two subjects were found. It was also found in this research that students with high levels of religiosity consider it more important to address the issues in question, with the majority being female students. Conclusion: It is necessary to include the topic in the medical academy, and it is essential to prepare a more humanistic and dedicated professional for patients, whether active or palliative treatment

Resiliência como fator de proteção aos transtornos mentais menores na equipe de enfermagem

OBJECTIVES: To track the presence of minor mental disorders and levels of resilience in nursing professionals who work in emergency services and inpatient units, as well as to verify possible associations between these variables and sociodemographic and professional characteristics. METHODS: Descriptive, correlational and cross-sectional study consisted of 203 nursing professionals (nurses, nursing technicians, and nursing assistants), from the country side of São Paulo State. Data collection was performed using a sociodemographic and professional characterization instrument and the Brazilian version of the Self-Report Questionnaire (SRQ-20) and the resilience scale. RESULTS: The overall prevalence of minor mental disorders among the participants was 31%, being lower among older professionals and men. The resilience of the professionals was high, with mean values ​​of 136.4 (±20.1) points. Older professionals and those who worked in emergency units had higher resilience scores. Lower resilience scores are associated with a greater possibility of minor mental disorders in this study. CONCLUSION: Resilience can be considered a protective factor against minor mental disorders in nursing professionals. Effective strategies must be taken into account to change this scenario of illness of a significant part of the nursing team.OBJETIVOS: Realizar un seguimiento de la presencia de trastornos mentales menores, evaluar los niveles de resiliencia de los profesionales de enfermería de los servicios de urgencias y unidades de internación y comprobar las posibles asociaciones entre estas variables y el perfil sociodemográfico y profesional. MÉTODOS: Estudio descriptivo, correlacional y transversal. Participaron 203 profesionales de enfermería (enfermeros, técnicos y auxiliares de enfermería), del interior del estado de São Paulo. La recolección de datos se realizó mediante una herramienta de caracterización sociodemográfica y profesional, el Cuestionario de Autoinforme (SRQ-20) y la escala de resiliencia. RESULTADOS: Prevalencia global de trastornos mentales menor al 31%, menor en profesionales mayores y varones. Alta resiliencia, con valores medios de 136,4 (±20,1) puntos. La edad avanzada y el desempeño en las unidades de emergencia obtuvieron puntajes de resiliencia más altos. Los puntajes de resiliencia más bajos se asocian con una mayor posibilidad de trastornos mentales menores en este estudio. CONCLUSIÓN: La resiliencia puede considerarse un factor protector frente a los trastornos mentales menores en los profesionales de enfermería. Se deben tener en cuenta estrategias efectivas para cambiar este escenario de enfermedad de una parte significativa del equipo de enfermería.OBJETIVOS: Rastrear a presença de transtornos mentais menores, avaliar os níveis de resiliência em profissionais de enfermagem de serviços de emergência e unidades de internação e verificar possíveis associações entre essas variáveis e o perfil sociodemográfico e profissional. MATERIAL E MÉTODO: Estudo descritivo, correlacional e transversal. Participaram 203 profissionais de enfermagem (enfermeiros, técnicos e auxiliares de enfermagem), do interior do estado de São Paulo. A coleta dos dados foi realizada por meio de instrumento de caracterização sociodemográfica e profissional, o Self-Report Questionnaire (SRQ-20), e da escala de resiliência. RESULTADOS: Prevalência global dos transtornos mentais menores de 31%, menor em profissionais de maior idade e do sexo masculino. Resiliência elevada, com valores médios de 136,4 (±20,1) pontos. Maior idade e atuação em unidades de emergência obtiveram escores mais elevados de resiliência. Menores escores de resiliência estiveram associados a maior possibilidade de transtornos mentais menores neste estudo. CONCLUSÕES: Resiliência pode ser considerada fator de proteção contra os transtornos mentais menores em profissionais de enfermagem. Estratégias efetivas devem ser levadas em conta para mudar esse cenário de adoecimento de parte significativa da equipe de enfermagem

Blended Learning Methods in Specialization Graduate Courses Improve the Knowledge Gain Metric

Information and communication technologies (ICT) have been proven beneficial in teaching of health sciences courses. Combined e-learning strategies with face-to-face activities, among others, are defining characteristics of a new learning perspective called blended learning methods. The paucity of data to confirm the benefits of online forms of learning, in isolation or as a part of a blended learning method, indicates that more studies are still required to assess their influence on the teaching-learning process. This study measured knowledge gained using face-to-face (FtFA) and distance educational on virtual learning environments (DA-VLE) strategies in health sciences. For two consecutive years, FtFA and DA-VLE education strategies were used in a discipline of specialization graduate course, each discussing two topics. The knowledge gained using each strategy was assessed for each topic using a pre (PT) and post-test (PoT). The performance frequency (PF) of participants was categorized based on the number of correct answers in each assessed. The PF frequency increased between the PA and PoT in both strategies (FtFA and - DA-VLE), although higher scores were observed in DA-VLE strategies when compared to FtFA strategies. These data indicate that such strategies, within this context, are vital, and can bring benefits to the teaching-learning process in combination

Are we teaching patient safety to our academics? : The experience of a course in the countryside of São Paulo

Nowadays, one of the biggest concerns in the health care field is centered on patient safety with a primary focus on the errors of the medical team. In 2009, WHO created a guide for universities aimed at patient safety in which it suggests new ways of approaching patients, thus improving the quality of trained professionals and dramatically reducing adverse events. There is a consensus that there is a restructuring of a system that currently presents serious failures that result in permanent harm to the objective of the medical team, which is the well-being of the patient, as well as an efficient inspection of the Decree Number 529/13 in Brazilian universities. It is in this context that the present work proposes to highlight the gap currently existing in Brazilian universities, based on the sampling of one of them, located in the countryside of São Paulo. Prospective intervention study using a quantitative and qualitative methodology, carried out in two stages: analysis of teaching plans and application of the quantitative and qualitative perception instrument to professors. Was not found in the teaching plans of the modules of the medical course at Universidade Brasil the concept of patient safety. Semi-structured questionnaire was answered by 47 teachers, 11 (23.4%) of the basic cycle and 36 (76.6%) of the clinical cycle and internship. Professors at Universidade Brasil consider that the themes are extensivily addressed in their classes, although they are not described in most of the modules\u27 teaching plans. Medical education in Brazil needs a qualitative leap, and that leap is certainly in the area of patient safety.  In the context of implementation, the multiprofessional edition of the World Health Organization (WHO) patient safety curriculum guide can be used as guidance and a current and very promising development in relation to the acquisition and examination of the skills necessary for safe care for the patient is the establishment of interprofessional training wards. Considering that medical students are the future driving force of change in health care, it is necessary to encourage quality improvement and patient safety education to offer the patient-centered. The graduation, at any time and since day one, is the moment of formation, therefore favorable to the teaching of this topic for students in the health care field, and all teachers should be involved with these contents.

Peer-Assisted Learning: A New Look at the Good Old Monitoring and Its Motivation from the Perspective of Student-Monitor

Peer-assisted learning (PAL), good old monitoring, has been used in medical schools and shown good results in professional development and in developing communication skills among students. This method provides mutual benefits for both monitors/near-peer teachers - NPT and monitored students; however, little is still known about the NPT’ perception about peer-assisted learning. To evaluate the real motivation of students to become NPT, and to investigate how NPT qualify their own teaching activities – such as productivity, performance and difficulties faced – seems to be a crucial step for implementing PAL in medical schools. The research instrument, a semi-structured questionnaire with 11 closed questions and 3 questions that allowed the answer “other” and further explanation, was answered by 26 medical students, NPT of basic disciplines. The results showed a positive effect of PAL on the teaching-learning process, and the real reasons of students to become NPT and the positive impacts of PAL on their academic life. The identification of these potential benefits should encourage medical schools to promote training so students can perform their role as NPT since PAL aids in the development of their clinical and pedagogical skills

Cell biology and histology in medicine: perception on education and student performance

The subjects areas of Cellular Biology and Histology, which underpin the microscopic field of Morphology and are included in the first years of the curriculum in a Medical course, are the pillars of medical education  and for the clinical reasoning of future professionals. This study aimed to trace a teaching profile of Cellular Biology and Histology in the Medical courses which had participants in the selection process to fill vacancies by transfer, for the undergraduate course in the Medical School of São José do Rio Preto (FAMERP)  in 2017. This was a quantitative and qualitative cross-sectional study and 132 academics participated. The results showed that, in most Higher Education Institutions, these disciplines are taught theoretically and practically. In the comparison between the theoretical performance of the students of traditional and active teaching-learning methodology, a higher number of hits in Histology and a better final grade were observed in the traditional. The deficiency pointed out by the students was a lack of laboratory sessions with viewing histological glass slides with light microscopes. Also, the aspect of teachers’ pedagogical practice and dynamic classes was shown to be fundamental to the students' interest, as well as to better satisfaction’s index in learning these areas. Furthermore, integrating these disciplines with the clinical practice of Medicine has proved to be relevant for academics, who feel more instigated to knowledge. In the present study, it was detected a better use in relation to the Histology by the students of the courses of traditional methodology, compared to those of active methodology and in this way the analysis done can to collaborate for the enrichment and reaffirmation of the fruits of the comparison of teaching-learning methodologies

VEGF Polymorphisms Related to Higher Serum Levels of Protein Identify Patients with Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the most common primary neoplasia of the liver. Major risk factors for hepatocellular carcinoma include chronic liver diseases, carcinogenic agents, and genetic alterations as well as vascular endothelial growth factor (VEGF) involved in angiogenesis process. The aim of this study was to evaluate the association of VEGF-A (C936T and A1154G) with HCC and cirrhosis, in addition to serum levels of VEGF, clinical profile, lifestyle habits, and comorbidities. A total of 346 individuals were studied: 102 with HCC (G1), 117 with cirrhosis (G2), and 127 controls (G3). Polymorphisms were analysed by PCR/RFLP and serum levels of VEGF by ELISA. Alpha error was set at 5%. The wild-type genotype of both polymorphisms prevailed (P>0.05). In G1, 23% of the patients died, with no relation to genetic profile (P>0.05). Increased VEGF level was observed in G1 and G3, related to the mutant allele of VEGF-C936T and VEGF-A1154G, respectively, and compared with the wild-type genotype (P=0.0285; P=0.0284, resp.) as well as G1 versus G2 and G3 for VEGF-C936T and G1 versus G2 for VEGF-A1154G (P<0.05 for both). In conclusion, there is a relationship between mutant alleles of VEGF-C936T and VEGF-A1154G polymorphisms and higher VEGF level, making them potential markers for HCC

Hepatic iron concentration in chronic hepatitis C: relationship with hepatic stellate cell activation and response to antiviral therapy

Background: The complex relationship between liver iron and fibrosis progression in chronic hepatitis C, possibly mediated by activation of hepatic stellate cells (HSC), as well as the impact of iron depositions on sustained virological response (SVR) to antiviral therapy remain inconclusive. Aims: To evaluate the relationship between hepatic iron concentration (HIC) and HSC activation and the influence of HIC on SVR. Patients and Methods: Patients with chronic hepatitis C and liver biopsy with tissue iron quantification by atomic absorption spectrophotometry were eligible for HSC measurement. Of these patients, those receiving ribavirin and interferon based therapy (24 or 48 weeks) were included for the assessment of the relationship between SVR and HIC. Fibrosis and necroinflammatory activity were classified according to the Brazilian Society of Pathology. Activated HSC measurement was carried out by immunohistochemical test with anti-smooth muscle ¥á-actin antibody; these cells were semiquantified according to the modified Schimitt-Graff et al. score, graded in the lobular (zone 1 and zones 2-3) and mesenchymal (portal tracts/fibrous septa) compartments. Spearman.s correlation coefficient was used to identify the association of HIC, activated HSC, necroinflammatory activity and fibrosis variables. HIC was compared in patients with and without SVR by Mann-Whitney and Fisher.s exact tests; p 800 ¥ìg/g reached statistical significance, p=0.04. Conclusions: HIC was not associated to greater HSC activation despite of the association of HSC activation with greater liver histological damage. In addition, HIC had a positive impact on SVR. Thus, in the context of physiological thresholds, there must be an optimal iron concentration range, which is beneficial for the host in relation with hepatitis C virus infection.Introducao: A complexa relacao entre ferro hepatico e progressao da fibrose na hepatite C cronica, possivelmente mediada pela ativacao de celulas estreladas hepaticas (CEH), bem como o impacto dos depositos de ferro sobre a taxa de resposta virologica sustentada (RVS) a terapia antiviral permanecem inconclusivos. Objetivos: Avaliar a relacao entre concentracao de ferro hepatico (CHF) e ativacao de CEH e a influencia da CFH sobre a taxa de RVS. Metodos: Foram elegiveis para estudo das CEH pacientes com hepatite C cronica e biopsia hepatica com quantificacao de ferro no tecido por espectrofotometria de absorcao atomica. Dentre estes pacientes, os que foram submetidos a terapia baseada em interferon e ribavirina (24 ou 48 semanas) foram incluidos para analise da relacao entre RVS e CFH. Fibrose e atividade necroinflamatoria foram graduadas segundo a Sociedade Brasileira de Patologia. Pesquisa de CEH ativadas foi realizada por exame imuno-histoquimico com anticorpo contra ƒ¿-actina de musculo liso; estas celulas foram semi-quantificadas de acordo com o escore de Schimitt-Graff et al. modificado, graduadas no compartimento lobular (zona 1 e zonas 2-3) e mesenquimal (espaco-porta/septos). Para identificar associacao entre as variaveis CFH, CEH ativadas, atividade necroinflamatoria e fibrose, utilizou-se o coeficiente de correlacao de Spearman. CFH foi comparada entre pacientes com e sem RVS, empregando-se os testes Mann-Whitney e exato de Fisher; p 800 ƒÊg/g alcancou significancia estatistica, p=0,04. Conclusoes: A CFH nao se associou a maior ativacao de CEH, a despeito da associacao desta ativacao com maior dano histologico hepatico. Alem disso, a CFH teve impacto positivo sobre a RVS. Assim, no contexto de limites fisiologicos, deve haver uma faixa otima de concentracao do ferro, que seja benefica para o hospedeiro na sua relacao com a infeccao pelo virus da hepatite C.TEDEBV UNIFESP: Teses e dissertaçõe