Educação para o Processo do Morrer e da Morte pelos Estudantes de Medicina e Médicos Residentes / Education on the Process of Dying and Death by Medical Students and Resident Doctors

RESUMO Introdução O processo do morrer e da morte é um tema gerador de reações distintas entre estudantes de medicina e médicos residentes, que são influenciados por suas experiências pessoais e profissionais prévias, bem como questões culturais, psicológicas, religiosas e outras. Objetivo Avaliar a educação de estudantes de medicina (EM) do Curso de Medicina da Universidade Federal do Paraná (CM-UFPR) e de médicos residentes (MR) do Hospital de Clínicas da UFPR (HC-UFPR) sobre a temática do morrer e da morte. Método Estudo observacional quantitativo. Foi elaborado um questionário autoaplicável composto por 28 perguntas de múltipla escolha para avaliar a educação sobre o processo do morrer e da morte, com elementos adaptados do Frommelt Attitude Toward Care of the Dying Scale Form B (FATCOD-B Scale). Resultados 805 EM responderam ao questionário de pesquisa (74,6% do total de alunos, matriculados no primeiro semestre de 2016) e 93 MR (73,8% do total de residentes de especialidades clínico-cirúrgicas, matriculados no ano de 2016). O relato de experiência de contato com pessoas em processo de morte aumentou, progressivamente, durante a maior parte dos períodos do CM, atingindo a quase totalidade de residentes de primeiro ano e a totalidade daqueles mais graduados, em todas as especialidades. Durante o curso de medicina, 40,1% dos estudantes e 51,1% dos médicos residentes receberam algum tipo de formação pedagógica para o processo do morrer e da morte. A influência da afiliação religiosa na educação para a morte foi admitida por 54% dos EM e 44,3% dos MR. 58% dos EM e MR referiram os sentimentos de frustração e impotência após as mortes de pacientes. O contato com pacientes em processo de morte gerou diversos sentimentos nos EM e MR, incluindo tristeza, angústia, esfriamento, aumento da sensibilidade, amadurecimento profissional, entre outros. Conclusão EM e MR relataram ter recebido escassa formação sobre a morte durante a faculdade, e suas percepções acerca do tema são influenciadas por múltiplos aspectos, como a religiosidade. O contato com a morte desperta reações igualmente diversificadas. Mais estudos são necessários para aprofundar a complexidade dessa temática no âmbito da formação médica.

ABSTRACT Introduction The process of death and dying is a theme that generates different reactions among medical students and resident doctors, being influenced by their personal and professional experiences as well as cultural, psychological, religious, and other characteristics. Objective To evaluate the education of medical students (MS) of the Federal University of Paraná (UFPR) and resident doctors (RD) at Hospital de Clínicas of the Federal University of Paraná (HC-UFPR) on the subject of dying and death. Method A quantitative observational study. A self-administered questionnaire was designed, with 28 multiple-choice questions, to evaluate education about the process of dying and death, with elements adapted from the Frommelt Attitude Toward Care of the Dying Scale Form B (FATCOD-B Scale). Results The questionnaire was completed by 805 MS (74.6% of the total number of students enrolled in the first semester of 2016) and 93 RD (73.8% of the total number of residents of clinical and surgical specialties enrolled in 2016). The report of experience of contact with dying people increased among the MS as they progressed through medical school, reaching near-totality among the first-year residents, and totality among those with the most specialized degrees in all specialties. 40.1% of the MS and 51.1% of the RD reported that they had received some kind of pedagogical orientation about death and dying during medical school. The influence of religious beliefs on education in this area was reported by 54% of the MS and 44.3% of the RD. 58% of the MS and RD reported feelings of frustration and impotence following patients' deaths. Contact with patients in the dying process produced a range of feelings and perceptions among the MS and RD, including sadness, anguish, distancing, increased sensitivity, and professional maturation, among others. Conclusion MS and RD reported that they received little training about death during their medical training, and that their perceptions about the subject are influenced by multiple variables, such as religious belief. Contact with death also provokes equally diverse reactions. More studies are needed, to deepen the complexity of this issue in the field of medical training.

Supervised dance intervention based on video game choreography increases quadriceps cross sectional area and peak of torque in community dwelling older women

Abstract AIMS the purpose of this study was to assess the effects of a supervised dance intervention based on video game choreography on isokinetic concentric and eccentric knee peak of torque (PT), quadriceps and hamstrings cross sectional area (CSA) and functionality in community-dwelling older women. METHODS Forty-seven older women were allocated in Control Group (CG, n=25) and Intervention Group (IG, n=22). The IG performed dance based on video game choreography (Dance Central, XBOX 360®, Kinect), during 12 weeks, ~40 minutes, 3x/week, without foam (1-6week) and with foam and visual disturbances (7-12 week). The pretest-training-posttest assessments included: isokinetic concentric and eccentric knee PT and CSA (Magnetic resonance imaging) of quadriceps and hamstrings and functional tests. RESULTS The light-to-moderate-intensity 12-weeks training increased 8.5% the eccentric PT of quadriceps at 60°/s (p=0.04) and 1.3% quadriceps CSA (p=0.02). CONCLUSIONS These findings suggest that dance training based on video game choreography can enhance PT and induce hypertrophy in community-dwelling older women.

Indicators of sarcopenia and their relation to intrinsic and extrinsic factors relating to falls among active elderly women / Indicadores de sarcopenia e sua relação com fatores intrínsecos e extrínsecos às quedas em idosas ativas

Abstract Introduction: Musculoskeletal aging can impair functional performance increasing the risk of falls. Objective: To analyze the correlation between sarcopenia and the intrinsic and extrinsic factors involved in falls among community-dwelling elderly women. Method: A cross-sectional study evaluated the number of falls of 85 active community-dwelling elderly women in the previous year and then divided them into two groups: non-fallers (n=61) and fallers (n=24). The sarcopenia indicators assessed were gait speed (GS, 10m); handgrip strength (HS); calf circumference; appendicular muscle mass index (DXA). Intrinsic factors: Mental State Examination (MSE); visual acuity; depression (GDS-30); hip , knee (Lequesne) and ankle/foot (FAOS) pain/function; vestibular function (Fukuda test); functional mobility and risk of falls (TUG); power (sitting and standing five times); gait (treadmill); fear of falling (FES-I-Brazil). Extrinsic factors: risk/security features in homes. The independent t test was applied for comparisons between groups and the Pearson and Spearman tests were used for correlations (p<0.05). Results: There was a moderate correlation between HS and GS in non-fallers (r=0.47; p=0.001) and fallers (r= 0.54; p=0.03). There was a moderate negative correlation (r= -0.52; p=0.03) between FES-I-Brazil and gait cadence in fallers. There was a greater presence of stairs (p=0.001) and throw rugs (p=0.03) in the homes of fallers than non-fallers. Conclusion: The elderly women were not sarcopenic. Elderly fallers presented inferior gait cadence and a greater fear of falling. Residential risks were determining factors for falls, and were more relevant than intrinsic factors in the evaluation of falls among active community-dwelling elders.

Resumo Introdução: O envelhecimento musculoesquelético pode prejudicar o desempenho funcional aumentando o risco de quedas. Objetivo: Analisar a correlação entre indicadores de sarcopenia e fatores extrínsecos e intrínsecos às quedas em idosas da comunidade. Método: Estudo transversal, 85 idosas ativas da comunidade foram questionadas sobre número de quedas no último ano e divididas em dois grupos: não caidoras (n=61) e caidoras (n=24). Indicadores de sarcopenia verificados: velocidade da marcha (VM, 10m); força de preensão manual (FPM); circunferência panturrilha; índice de massa muscular apendicular (DXA). Fatores intrínsecos: estado mental (MEEM); acuidade visual; depressão (GDS-30); dor/função quadril, joelho (Lequesne) e tornozelo/pé (FAOS); função vestibular (teste Fukuda); mobilidade funcional e risco de quedas (TUG); potência (teste sentar e levantar cinco vezes); marcha (esteira); medo de cair (FES-I-Brasil). Fatores extrínsecos: riscos/recursos de segurança nas residências. Teste t independente para comparações entre grupos e correlação de Pearson e Spearman (p<0,05). Resultados: Correlação moderada entre FPM e VM para não caidoras (r=0,47; p=0,001) e caidoras (r=0,54; p=0,03). Correlação moderada negativa (r=-0,52; p=0,03) entre medo de cair e cadência da marcha de caidoras. Maior presença de escadas (p=0,001); tapetes soltos (p=0,03) nas residências das caidoras comparados com não caidoras. Conclusão: As idosas não apresentaram sarcopenia. Idosas caidoras apresentaram pior cadência da marcha e maior medo de cair. Riscos residenciais foram determinantes para cair, indicando maior relevância do que fatores intrínsecos na avaliação de quedas em idosas ativas da comunidade.

Elderly men's quality of life and lower urinary tract symptoms: an intricate relationship

PURPOSE: To evaluate the impact of lower urinary tract symptoms (LUTS) on the quality of life (QoL) in a group of elderly men. MATERIALS AND METHODS: Observational clinical study contained 200 men recruited between March-September 2008 in the community and Urology and Geriatrics ambulatories. The data collected included health and sociodemographic conditions; the International Prostate Symptom Score (IPSS); an anxiety/depression inventory; the World Health Organization Quality of Life -Bref and -Old questionnaires (WHOQoL). Participants were classified according to IPSS: Group I (moderate/severe symptoms) and Group II (absence/mild symptoms) and 100 men were included in each group. RESULTS: The groups were statistically similar in sociodemographic, morbidity, and anxiety/depression scores. Both QoL scales showed significant lower median scores in group I in all parameters, except the global subjective self-evaluation of QoL. The domains social and environmental relations presented the most significative differences (p < 0.0005) in both questionnaires, and final mean WHOQoL-OLD score was lower in group I (p < 0.0005). CONCLUSIONS: For elderly men, moderate to severe LUTS do significantly impact almost all parameters of QoL proposed by the WHO, especially social and environmental relations.

HIV prevalence among blood donors in a blood bank in Curitiba (Brazil)

There still is no cure for the acquired immunodeficiency syndrome (AIDS). Its etiologic agent is the human immunodeficiency virus (HIV), and transmission occurs through sexual relationships, contacts with blood, and vertically (mother to child). In this study, we sought to determine the prevalence of HIV among blood donors at a blood bank in Curitiba. We studied 213,666 blood donations made from March 1, 1992, to April 25, 1999. Each potential blood donor first answered a questionnaire, submitted to a clinical examination, and filled out a self-exclusion card. Blood was collected and analyzed only from the candidates approved by the first two criteria. Two tests were used to detect HIV: ELISA for screening, and Western-Blot for confirmation. The results were analyzed statistically by determining the 95 confidence interval. Of the total number of donors, 156,942 were men, and 56,724 were women. There were 319 cases of HIV infection (244 men, 75 women). There were no significant differences between genders, or among the different age groups, or between first-donation and repeated-donation donors. There was a significant predominance of HIV infection among single individuals compared to married, widowed, and other individuals. The same occurred among married and divorced individuals compared to widowed subjects. The prevalence of HIV among blood donors was 0.149 (0.155 among men and 0.132 among women). The frequency of HIV was statistically identical among new blood donors and repeat donors. A large number of HIV-infected married women was also observed.