A ESCOLHA PELA MEDICINA DE FAMÍLIA ENTRE ESTUDANTES DE MEDICINA NO MUNDO TROPICAL: UMA REVISÃO DE LITERATURA CAREER CHOICE FOR FAMILY MEDICINE AMONG MEDICAL STUDENTS IN TROPICAL WORLD: A LITERATURE REVIEW

ResumoIntrodução: A Medicina de Família é a especialidade essencial para o fortalecimento da Atenção Primária à Saúde no mundo. Várias pesquisas evidenciam a escassez deste especialista afim de garantir cobertura universal e sustentável dos sistemas de saúde. Métodos: Revisão de literatura de pesquisas realizadas nas regiões tropicais do mundo nos últimos 10 anos que investigaram fatores influenciadores da escolha pela Medicina de Família e Comunidade (MFC) entre estudantes de medicina. Seguiu-se o Protocolo Internacional com Itens Preferenciais para Relatórios de Revisão Sistemática de Literatura (PRISMA). Os critérios de inclusão foram: pesquisa original (qualitativa ou quantitativa), realizada entre estudantes de medicina, localizada entre os trópicos, inclusão da escolha pela Medicina de Família como categoria de análise. Resultados: Encontrados 10(dez) artigos que apontaram um prestígio da especialidade menor do que nas regiões temperadas, baixa inserção da MFC nos currículos médicos nas regiões tropicais. Verificamos ainda uma limitação para a realizarmos uma análise comparada, diante da baixa produção científica, a falta de métodos validados e replicados e da confusão de termos entre médicos generalistas (Recém-Formados) e especialistas em MFC. Considerações finais: A agenda de pesquisa que busque compreender os fatores influenciadores da escolha pela MFC entre estudantes de medicina deve ser ampliada, especialmente nos países tropicais. Os currículos médicos devem ser modificados para contemplar mais a MFC como especialidade médica e as políticas públicas precisam valorizar o papel deste profissional nos Sistemas de Saúde destes países. Palavras-chave:Atenção primária à saúde. Estudantes de medicina. Escolha de profissão. Medicina de família e comunidade. Zona tropical. AbstractIntroduction: Family Medicine is the essential speciality for strengthening primary health care in the world. Several surveys show the shortage of this expert in order to ensure universal coverage and sustainable health systems. Methodology: Literature review of researches conducted in the tropical regions of the world in the last 10 years that investigated factors influencing the choice of the Family Medicine (FM) among medical students. This study was designed following the International Protocol with Preferred Items for Systematic Literature Review Reports (PRISMA). Inclusion criteria were: original research (qualitative or quantitative), conducted among medical students, located between the tropics, including the choice of Family Medicine as a category for analysis. Results: Ten (10) researches were found that showed a less prestige of the FM than in temperate regions, low insertion of FM in medical curriculum in the tropics. We also found a limitation to conduct a comparative analysis on the low scientific production, the lack of validated and replicated methods and confusion of terms between generalists (without specialization) and specialized Family Doctors. Final Considerations: The research agenda that seeks to understand the factors influencing the choice for FM among medical students should be expanded, especially in tropical countries. Medical curriculum should be modified to contemplate more the FM as a medical specialty and public policies need to enhance the role of the professional in the health systems of these countries. Keyword:Primary health care. Medical students. Career choice. Family practice. Tropical zone

Fatores influenciadores na escolha pela medicina de família segundo estudantes numa região neotropical do Brasil

Objetivo: Analisar as percepções de estudantes, em uma escola médica no interior do estado de Goiás, sobre os fatores influenciadores na escolha ou na repulsa estudantil pela carreira em Medicina de Família e Comunidade. Metodologia: Pesquisa qualitativa, exploratória e transversal. Foi adotada a Análise de Conteúdo, de Laurence Bardin. O instrumento adotado foi um roteiro para entrevista semiestruturada e um questionário socioeconômico. O roteiro possuía perguntas fechadas abordando a preferência do aluno por determinadas especialidades médicas. A partir daí, perguntou-se por que escolheram ou não a Medicina de Família e Comunidade. Roteiro aplicado em 2013, para todos os 42 estudantes do último ano de um curso de medicina. Resultados: Nenhum estudante pesquisado escolheu a Medicina de Família e Comunidade. A relevância social da profissão, a abrangência de diversos problemas na prática clínica, o vínculo contínuo com pacientes, uma exposição maior a esta especialidade e, principalmente, a presença de médicos de família na graduação seriam influências positivas para a escolha destes alunos pela Medicina de Família e Comunidade. O desprestígio na universidade, identificado no discurso de professores e médicos preceptores, além da falta de reconhecimento da sociedade e a baixa remuneração foram os principais fatores desmotivadores na escolha pela área. Conclusão: A valorização da Medicina de Família e Comunidade, com o aumento da participação de mais especialistas no curso de medicina, além de uma valorização na comunidade universitária e na gestão do sistema de saúde podem ser ações que provoquem uma atração maior de estudantes para esta especialidade

ANALGESIA POSTOPERATORIA CON ANESTESIA GENERAL BALANCEADA Y BLOQUEO DE ESCALPE EN PACIENTES ADULTOS SOMETIDOS A CRANEOTOMÍA: ROPIVACAÍNA-BUPRENORFINA VS ROPIVACAÍNADEXMEDETOMIDINA.

El dolor no siempre es proporcional a la magnitud de la agresión quirúrgica a los tejidos, pues es muy variable de una persona a otra, incluso de 10 a 15 % de los pacientes postoperados no sufren de dolor o solo un dolor leve. En el dolor postoperatorio intervienen múltiples interacciones de naturaleza inflamatoria, neurofisiológica y física. El carácter y la localización del dolor son junto con la técnica quirúrgica los factores determinantes mas importantes, pero el tipo de anestesia y de analgesia y los factores psíquicos ocupan también un lugar importante. Se ha observado que los pacientes sometidos a craneotomía sufren de dolor agudo postoperatorio hasta en un 40%. Esta situación puede desencadenar complicaciones intrahospitalarias como alteraciones hemodinámicas con repercusión en la fisiología cerebral, mal uso de analgésicos de rescate y una mala experiencia por parte del paciente que puede traerle repercusiones emocionales futuras.La International association for the study of pain (asociation internacional para el estudio del dolor) define al mismo como una experiencia sensorial y emocional desagradable con daño tisular actual, potencial o descrito en términos de dicho daño

A ESCOLHA PELA MEDICINA DE FAMÍLIA ENTRE ESTUDANTES DE MEDICINA NO MUNDO TROPICAL: UMA REVISÃO DE LITERATURA CAREER CHOICE FOR FAMILY MEDICINE AMONG MEDICAL STUDENTS IN TROPICAL WORLD: A LITERATURE REVIEW

Introduction: Family Medicine is the essential speciality for strengthening primary health care in the world. Several surveys show the shortage of this expert in order to ensure universal coverage and sustainable health systems. Methodology: Literature review of researches conducted in the tropical regions of the world in the last 10 years that investigated factors influencing the choice of the Family Medicine (FM) among medical students. This study was designed following the International Protocol with Preferred Items for Systematic Literature Review Reports (PRISMA). Inclusion criteria were: original research (qualitative or quantitative), conducted among medical students, located between the tropics, including the choice of Family Medicine as a category for analysis. Results: Ten (10) researches were found that showed a less prestige of the FM than in temperate regions, low insertion of FM in medical curriculum in the tropics. We also found a limitation to conduct a comparative analysis on the low scientific production, the lack of validated and replicated methods and confusion of terms between generalists (without specialization) and specialized Family Doctors. Final Considerations: The research agenda that seeks to understand the factors influencing the choice for FM among medical students should be expanded, especially in tropical countries. Medical curriculum should be modified to contemplate more the FM as a medical specialty and public policies need to enhance the role of the professional in the health systems of these countries

Relationship between bone mineral density, leptin and insulin concentration in Brazilian obese adolescents

Despite the epidemic of adolescent obesity, the effect of obesity and hormones on bone mineral accrual during growth is poorly understood. Studies using dual-energy X-ray to examine the effect of obesity on bone mass in children and adolescents have yielded conflicting results. the aim of this study was to explore the combined and independent contributions of body mass index, body composition, leptin, insulin, glucose levels and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) to bone mineral density (BMD) and bone mineral content in a group of Brazilian obese adolescents. This study included 109 post-pubescent obese adolescents. A whole-body dual-energy X-ray absorptiometry scan was performed,using a HOLOGIC QDR4200, to determine whole-body BMD and body composition. Blood samples were collected in the outpatient clinic after an overnight fast, and evaluated for fasting blood glucose and immunoreactive insulin. Leptin levels were assessed with a radioimmunoassay kit. Insulin resistance was assessed by HOMA-IR and the quantitative insulin sensitivity check index. Our results showed that insulin levels and HOMA-IR correlated negatively with BMD and a linear regression analysis showed that serum leptin is inversely associated to BMD adjusted for body mass. in conclusion, our data support the hypothesis that leptin, insulin and HOMA-IR are inversely associated with BMD and play a significant direct role in bone metabolism.CENESPFADAFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)CEPID/SleepUNIFESPUniversidade Federal de São Paulo, Nutr Postgrad Program, Paulista Med Sch, BR-04020060 São Paulo, BrazilUniv Pernambuco, Phys Educ High Sch, Recife, PE, BrazilUniv Ribeirao Preto UNAERP, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, Paulista Med Sch, BR-04020060 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biosci, Paulista Med Sch, BR-04020060 São Paulo, BrazilUniversidade Federal de São Paulo, Nutr Postgrad Program, Paulista Med Sch, BR-04020060 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, Paulista Med Sch, BR-04020060 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biosci, Paulista Med Sch, BR-04020060 São Paulo, BrazilFAPESP: 2006/00684-3FAPESP: 2008/53069-0CEPID/Sleep: 9814303-3 stWeb of Scienc

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN

Measurement of inclusive and differential cross sections of single top quark production in association with a W boson in proton-proton collisions at s\sqrt{s} = 13.6 TeV

International audienceThe first measurement of the inclusive and normalised differential cross sections of single top quark production in association with a W boson in proton-proton collisions at a centre-of-mass energy of 13.6 TeV is presented. The data were recorded with the CMS detector at the LHC in 2022, and correspond to an integrated luminosity of 34.7 fb$^{-1}$. The analysed events contain one muon and one electron in the final state. For the inclusive measurement, multivariate discriminants exploiting the kinematic properties of the events are used to separate the signal from the dominant top quark-antiquark production background. A cross section of 82.3 $\pm$ 2.1 (stat) ${}^{+9.9}_{-9.7}$ (syst) $\pm$ 3.3 (lumi) pb is obtained, consistent with the predictions of the standard model. A fiducial region is defined according to the detector acceptance to perform the differential measurements. The resulting differential distributions are unfolded to particle level and show good agreement with the predictions at next-to-leading order in perturbative quantum chromodynamics

Search for bottom quark associated production of the standard model Higgs boson in final states with leptons in proton-proton collisions at s\sqrt{s} = 13 TeV

International audienceThis Letter presents the first search for bottom quark associated production of the standard model Higgs boson, in final states with leptons. Higgs boson decays to pairs of tau leptons and pairs of leptonically decaying W bosons are considered. The search is performed using data collected from 2016 to 2018 by the CMS experiment in proton-proton collisions at a centre-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 138 fb${-1}$. Upper limits at the 95% confidence level are placed on the signal strength for Higgs boson production in association with bottom quarks; the observed (expected) upper limit is 3.7 (6.1) times the standard model prediction