Vaccination coverage and immunity against hepatitis B among HIV-infected patients in South Brazil

Evidence-based strategies to improve the hepatitis B virus (HBV) vaccination coverage rates might help to reduce the burden caused by co-infection with HBV and human immuno-deficiency virus (HIV). In this study, the aim was to evaluate the vaccination coverage and immunity against HBV among HIV-infected individuals in South Brazil, and identify factors that are associated with compliance patterns and antibody reactivity. Three hundred HIV-infected men and women were included in this survey. The patients answered a standardized questionnaire, and vaccination cards were checked in order to assess hepatitis B vaccine status. A blood sample was collected for quantitative determination of antibody to hepatitis B virus surface antigen (anti-HBs). Participants were also evaluated for their CD4 cell count and HIV viral load. The overall vaccination coverage of HBV vaccination found in this study (57.4%) was lower than that was previously reported in South Brazil. Anti-HBs levels >10 IU/L were observed in 47.0% of the studied population. A significant inequality in the coverage rates and antibody reactivity was found in favor of patients with better economic status. In conclusion, the results indicate the need for improvement in the HBV vaccination coverage among HIV carriers, in particular focusing on low-income individuals.

Nível de conhecimento sobre glaucoma primário de ângulo aberto entre os estudantes de medicina / Knowledge about primary open angle glaucoma among medical students

Objetivo: Avaliar o conhecimento dos alunos de graduação do curso de Medicina da Universidade Federal de Juiz de Fora em relação ao glaucoma primário de ângulo aberto. Métodos: Neste estudo transversal, aplicou-se aos alunos dos 5º e 6º ano um questionário contendo 11 questões referentes a epidemiologia, fatores de risco, sintomas, diagnóstico, tratamento, consequências do glaucoma e por último se consideram os conhecimentos adquiridos na universidade como suficientes. Características dos alunos (idade, sexo, especialidade pretendida) foram identificadas. Resultados: Entre os estudantes, 52,9% eram mulheres. A origem genética da doença foi identificada por 22,5%. Quase a metade (46,1%) não sabia que o glaucoma na maioria das vezes é assintomático. Aproximadamente 1 em cada 3 alunos não sabia que a cegueira do glaucoma era irreversível. A grande maioria (91,2%) identificou corretamente que a tonometria era um exame importante na avaliação do glaucoma e que o tratamento poderia ser clínico (70,6%) ou cirúrgico (71,6%). Porém, poucos alunos deram a real importância para os exames de fundoscopia (35,3%) e campimetria (28,7%). Quase a totalidade (95,1%) dos entrevistados considerou o próprio conhecimento como insuficiente. Conclusão: A maioria dos entrevistados acha que o conhecimento sobre glaucoma primário de ângulo aberto adquirido na graduação é insuficiente. Tal desconhecimento pode levar a oportunidades de diagnóstico perdidas e gerar consequências graves tanto do ponto de vista individual (cegueira) quanto do ponto de vista coletivo (impacto para o sistema de saúde e sociedade). .

Objective: To assess the knowledge of primary open-angle glaucoma among medical students from Federal University of Juiz de Fora. Methods: In this cross sectional study, we conducted a survey among students attending the last two years of Medical School. The questionnaire consisted in 11 questions about epidemiology, risk factors, symptoms, diagnosis, treatment and primary openangle glaucoma (POAG) consequences. The students were also asked if they considered their knowledge about POAG sufficient. Students’ characteristics (age, sex and intended area of specialization) were identified. Results: Women comprised 52.9% of the students. Only 22.5% identified POAG as having a genetic origin. Almost half of them (46.1%) did not know that POAG is asymptomatic and 1 out of 3 students did not know that glaucoma blindness is irreversible. The great majority (91.2%) correctly identified tonometry as an important tool for diagnosis and that glaucoma can be treated through medications (70.6%) or surgery (71.6%). However, few students identified fundoscopy (35.3%) and perimetry (28.7%) as important tools for glaucoma assessment. Almost everyone (95.1%) considered their knowledge insufficient. Conclusion: The majority of the participants believe that their knowledge of POAG is insufficient. This gap can lead to some serious consequences from both individual (blindness) and collective (negative impact in health system and society) perspectives. .

The prevalence of hepatitis B virus infection markers and socio-demographic risk factors in HIV-infected patients in Southern Brazil

Introduction Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections are two of the world's most important infectious diseases. Our objective was to determine the hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc) prevalences among adult HIV-infected patients and identify the associations between socio-demographic variables and these HBV infection markers. Methods This study was performed from October 2012 to March 2013. Three hundred HIV-seropositive patients were monitored by the Clinical Analysis Laboratory of Professor Polydoro Ernani de São Thiago University Hospital, Santa Catarina, Brazil. The blood tests included HBsAg, anti-HBc immunoglobulin M (IgM) and total anti-HBc. Patients reported their HIV viral loads and CD4+ T-cell counts using a questionnaire designed to collect sociodemographic data. Results The mean patient age was 44.6 years, the mean CD4 T-cell count was 525/mm3, the mean time since beginning antiretroviral therapy was 7.6 years, and the mean time since HIV diagnosis was 9.6 years. The overall prevalences of HBsAg and total anti-HBc were 2.3% and 29.3%, respectively. Among the individuals analyzed, 0.3% were positive for HBsAg, 27.3% were positive for total anti-HBc, and 2.0% were positive either for HBsAg or total anti-HBc and were classified as chronically HBV-infected. Furthermore, 70.3% of the patients were classified as never having been infected. Male gender, age >40 years and Caucasian ethnicity were associated with an anti-HBc positive test. Conclusions The results showed an intermediate prevalence of HBsAg among the studied patients. Moreover, the associations between the anti-HBc marker and socio-demographic factors suggest a need for HBV immunization among these HIV-positive individuals, who are likely to have HIV/HBV coinfection. .

Currículo paralelo na graduação médica na perspectiva dos estudantes / Students? perspectives on the parallel curriculum in medical schools

Introdução: o termo ?currículo? pode ser interpretado como ?grade? de disciplinas e cargas horárias da instituição de ensino. Existe o currículo formal, constituído por conteúdo didático e atividades práticas, estruturado oficialmente pelas faculdades, e o currículo paralelo (CP), contemplando atividades não determinadas pela instituição, mas relevantepara formação médica. A construção de um CP pelo estudante possui inúmeras motivações e não está isenta de obstáculos. Objetivo: traçar o perfil das atividades desenvolvidas, motivações, dificuldades e satisfação dos acadêmicos imbuídos em desempenhar atividades extracurriculares (AE). Métodos: utilizou-se entrevista estruturada com 10 perguntas, aplicada a 280 acadêmicos do curso de Medicina. Resultados: a maioria dos entrevistados já participou de alguma AE, 96,4% (n=270), sendo a disciplina optativa a mais realizada; no currículo formal, 55,4% (n=155) desejam incluir cursos de aperfeiçoamento; 45% (n=126), treinamento profissional; a principal motivação foi desejo de aprimorar currículo ? 73,9% (n=207). Como maiores obstáculos: a escassez de vagas, 51,8% (n=145), e a disponibilidade de horários, 50% (n=140). Conclusões: a amostra apresentou elevada participação em AE, destacadas as que promovem o aperfeiçoamento da prática, aprimoramento do currículo e que permitem melhor pontuação nos concursos de residência médica, sendo o período mais avançado um fator de risco para a execução. São majoritariamente supervisionadas por médico docente e contemplam alto índice de satisfação. Diante desse panorama, sugere-se a incorporação de algumas das atividades extracurriculares no currículo formal, priorizando o aperfeiçoamento da prática clínica, que poderá incrementar o nível da formação resultando em profissionais mais capacitados e seguros em exercer a Medicina...

Introduction: the term ?curriculum? can be interpreted as a ?grid? of courses and the contact hours in an education institution. There is a formal curriculum, consisting of taught content and practical activities officially organized by the faculty, and a parallel curriculum (PC) coveringactivities that although not determined by the institution are relevant to a medical education. For students, structuring the CP comes with numerous motivations but is not without obstacles. Objective: to define the profile of activities developed, motivation, difficulties, and satisfaction among students performing extracurricular activities (EA). Methods: 10-question structured interviews with 280 medical students. Results: most respondents (96.4%, n=270) had already taken part in at least one EA, making it the most popular optional course in the formal curriculum. 55.4% (n=155) wished to include improvement courses and 45% (n=126) professional training. The main motivation was the desire to enhance the curriculum, cited by 73.9% (n=207). Main obstacles were the limited number of takings (51.8% n=145), and conflict of schedules (50%, n=140). Conclusions: This sample showed a high number of students engaged in EA, especially among those that lead to practice improvement, CV enhancement and score better in residency requirements. Being closer to graduation represented a risk factor for completing these EA.Most EAs are supervised by teaching physicians and were considered highly satisfactory. With this in view, we suggested that some of the extracurricular activities be included in the formal curriculum, prioritizing the improvement of clinical practice. This addition has the potential of increasing the level of training and result in more skilled and confidentmedical professionals...