RESUMO
Resumo: Introdução: A literatura refere como frequentes denúncias sobre má prática médica. Logo, a investigação de como é feita a formação do acadêmico de Medicina, no contexto ético-legal, pode contribuir para sua melhoria. Objetivo: Este estudo teve como objetivos avaliar e comparar o conhecimento de acadêmicos de uma faculdade de Medicina sobre aspectos ético-legais da profissão, a partir de sua formação nas disciplinas do eixo relacionado ("Ética Médica e Bioética", "Medicina Legal" e "Deontologia/Perícia Médica e Boas Práticas"). Método: Trata-se de um estudo transversal com aplicação de questionário (agosto-novembro/2020) estruturado no Código de Ética Médica e Código de Ética do Estudante de Medicina - dez questões sociodemográficas e 12 objetivas (temas: "sigilo profissional", "relações interpessoais do estudante de Medicina", "publicidade médica", "relação com pacientes e familiares", "direitos humanos", "princípios fundamentais", "atividade médica" e "telemedicina"). Avaliaram-se 116 alunos: início, meio (durante curso do eixo ético-legal) e final da graduação. Para comparação, utilizaram-se os testes de Kruskal-Wallis e de Dunn. Para associação entre variáveis categóricas, adotaram-se o qui-quadrado e o teste exato de Fisher. Resultado: Identificou-se desempenho crescente com o avançar dos períodos, com diferença estatística entre as médias de acertos do primeiro, sexto e décimo/12°: 5,1; 6,7; e 7,8, (valor-p < 0,001). Já a análise por blocos temáticos não apontou associação estatística dos acertos com avançar na graduação (valor-p > 0,05) para temas de amplo alcance e desenvolvimento das competências desde o ciclo básico, como "publicidade médica", "relação com pacientes e familiares", "telemedicina" e "relações interpessoais do estudante de Medicina" - com ênfase em limitações do acadêmico no atendimento. Já para temas que exigiam competências inerentes às disciplinas do eixo ético-legal, encontrou-se tal associação (valor-p < 0,05), sendo: "sigilo profissional", "direitos humanos", "princípios fundamentais", "atividade médica" e "relações interpessoais do estudante de medicina" - especificamente sobre uso de eletrônicos. Por fim, o maior percentual de acertos (95,7%) associa-se às "relações interpessoais do estudante de Medicina", com ênfase nas limitações do acadêmico. Já as menores taxas apresentaram-se em "sigilo profissional" (18,1%), "atividade médica" (33,6%) e "direitos humanos" (25%)". Conclusão: Existe associação entre a formação proposta pelo eixo ético-legal e aumento efetivo do nível de conhecimento no acadêmico de Medicina sobre os aspectos ético-legais da profissão.
Abstract: Introduction: Complaints about medical malpractice are frequent. Therefore, investigating how the medical student formation is made concerning the ethical and legal aspects, can contribute to its improvement. Objective: To evaluate and compare the level of knowledge of medical students from a university about ethical and legal aspects of the profession, based on their formation in the disciplines of the related axis (Medical Ethics and Bioethics; Legal Medicine and Deontology/Medical Forensics and Good Practice). Method: Cross-sectional study carried out through the application of an online questionnaire (August-November/2020) based on the Code of Medical Ethics (CME) and the Code of Ethics for Medical Student- 10 sociodemographic and 12 objective questions (Topics: "Professional Confidentiality", "Medical student's Interpersonal Relations", "Medical Publicity", "Relations with Patients and Families", "Human Rights", "Fundamental Principles", "Medical Activity" and "Telemedicine"). A total of 116 students were evaluated at the start, middle and end of the medical course. The Kruskal-Wallis and Dunn tests were used for comparisons. The Chi-Square and Fisher's exact tests were used for the association of categorical variables. Results: The performance increased throughout the course, with statistical significance between the average number of correct answers in the 1st, 6th and 10th/12th periods: 5.1; 6.7 and 7.8, (p-value <0.001). The analysis by thematic blocks, on the other hand, did not show a statistical association of correct answers with progress in the medical course (p-value >0.05) for broad-reaching topics and development of competences from the basic cycle, such as "Medical Publicity", "Relations with Patients and Families", "Telemedicine" and "Medical Student's Interpersonal Relations" - with emphasis on the student's limitations in providing care. As for topics that required competences inherent to the disciplines of the ethical-legal axis, this association was identified (p-value <0.05), as follows: "Professional Confidentiality", "Human Rights", "Fundamental Principles", "Medical Activity" and "Medical Student's Interpersonal Relations" - specifically on the use of electronics. Finally, the highest percentage of correct answers (95.7%) is associated with "Medical Student's Interpersonal Relations", with an emphasis on the student's limitations. While the lowest rates were found in "Professional Confidentiality" (18.1%), "Medical Activity" (33.6%) and "Human Rights" (25%)". Conclusion: There is an association between the medical formation proposed by the ethical-legal axis, and the effective increase of the medical student's level of knowledge concerning the ethical-legal aspects of the profession.
RESUMO
ABSTRACT Objective: This study aimed to assess vitamin D (25OHD) levels in individuals who underwent an examination at a private laboratory (between latitudes 14° and 22° south) over 14 years, stratified by sex, age, and epidemiological profiles, and determine variations in the number of tests performed over the years. Materials and methods: All records of 25OHD tests performed at a private clinical laboratory in Brazil were analyzed. This retrospective cross-sectional study included patients stratified by sex (female or male), age range (0-17, 18-40, 41-59, and ≥ 60 years), and year of testing. The final sample size was 193,725 patients. Categorical variables are presented as absolute and relative frequencies and numerical variables as means ± standard deviation. Comparisons between groups were performed using the equality of proportions test. Results: The number of tests performed steeply increased since 2010. More tests were performed in female individuals (73.3%) and individuals aged 41-59 years (32.2%). Most samples (68.0%) demonstrated sufficient vitamin D status. Women had a higher incidence of vitamin D deficiency than men (33.1% and 26.6%, respectively; p < 0.001). Individuals aged ≥ 60 years had the highest incidence of vitamin D deficiency (68.4%), while individuals aged 0-17 years had the lowest (32.2%) (p < 0.001). Conclusion: Despite increased testing and attention given to vitamin D in recent years, our study demonstrates high levels of deficiency in a country with geographical conditions favorable to its production.