Use of Active Learning During Emergency Remote Teaching in COVID-19 Pandemic.

The mandatory isolation caused by COVID-19 required the adoption of emergency remote teaching, which caused difficulties for instructors, especially for those who use active learning that depends on student participation in class. This study aimed to investigate the ability of instructors to apply active learning effectively given the pandemic context. This was a cross-sectional observational study carried out in an undergraduate medical school. The sample was composed from one to three classes of 28 instructors that were observed synchronously. Each class was analyzed using a form created from an adaptation of the PORTAAL tool, aiming to evaluate quantitatively essential elements for active learning. We observed that the mean times devoted to activities and active participation of students were 54.8% and 33.1% of the total class time, respectively. Among the time spent in student interactions, the intra-group demanded the highest percentage of the class time. Additionally, 22.0% of the activities presented a high level in Bloom's taxonomy and there was a positive correlation between the percentage of activities at higher Bloom levels and the percentage of class time with student participation, intra-group or between-group interactions, supporting the use of higher-order cognitive skills in a collaborative and student-centered context. In conclusion, our findings indicate that some instructors were able to apply essential elements for an active and collaborative learning even during the emergency remote teaching.

Virtual Reality as a Complementary Learning Tool in Anatomy Education for Medical Students.

Virtual reality seems to be a promising tool to improve the study of anatomy; however, its efficacy compared to traditional methods remains unclear. This randomized experimental study included 42 first-semester medical students enrolled in a Morphology discipline, divided into two groups. Each group was interchangeably assigned to use virtual reality plus traditional methods or traditional methods alone in a four-section crossover design. Participants' scores in four distinct tests were compared between groups, as well as a motivation questionnaire. The results showed that virtual reality does not provide significant increase on scores neither short-, medium-, and long-term analysis. Nonetheless, in the motivation questionnaire, participants agreed virtual reality provides a better tridimensional view of the human body and therefore is a potential complementary tool when learning anatomy. We conclude virtual reality does not seem to have an impact on academic performance, but it was perceived as an engaging and promising complementary tool for the study of anatomy.

Sarcopenic obesity definitions and their associations with physical frailty in older Brazilian adults: data from the SARCOS study

ABSTRACT Objective: To identify the obesity diagnosis with the highest association with physical frailty associated with sarcopenia EWGSOP II (sarcopenic obesity). Subjects and methods: We performed a cross-sectional analysis of 371 community-dwelling older adults. Appendicular skeletal lean mass and total body fat (TBF) were assessed using dual-energy x-ray absorptiometry, and physical frailty was defined using Fried's criteria. The phenotypes were identified according to the presence of sarcopenia by EWGSOP II and obesity, which was diagnosed using two concepts: BMI obesity (BMI ≥ 30 kg/m2) and TBF obesity (percentage of TBF ≥ 35% for women and ≥ 25% for men). Finally, the association of each group with physical frailty was evaluated. Results: The mean age was 78.15 ± 7.22 years. Sarcopenia EWGSOP II was diagnosed in 19.8% (n = 73), body mass index obesity was identified in 21.8% (n = 81), TBF obesity was identified in 67.7% (n = 251), and physical frailty was identified in 38.5% (n = 142). In a regression analysis for frailty, sarcopenic TBF obesity presented an odds ratio of 6.88 (95% confidence interval 2.60-18.24; p < 0.001). Conclusion: In older Brazilian adults, sarcopenic obesity diagnosed by TBF obesity has a robust association with frailty and is independent of body mass index.

Sarcopenic obesity definitions and their associations with physical frailty in older Brazilian adults: data from the SARCOS study.

Objective: To identify the obesity diagnosis with the highest association with physical frailty associated with sarcopenia EWGSOP II (sarcopenic obesity). Subjects and methods: We performed a cross-sectional analysis of 371 community-dwelling older adults. Appendicular skeletal lean mass and total body fat (TBF) were assessed using dual-energy x-ray absorptiometry, and physical frailty was defined using Fried's criteria. The phenotypes were identified according to the presence of sarcopenia by EWGSOP II and obesity, which was diagnosed using two concepts: BMI obesity (BMI ≥ 30 kg/m2) and TBF obesity (percentage of TBF ≥ 35% for women and ≥ 25% for men). Finally, the association of each group with physical frailty was evaluated. Results: The mean age was 78.15 ± 7.22 years. Sarcopenia EWGSOP II was diagnosed in 19.8% (n = 73), body mass index obesity was identified in 21.8% (n = 81), TBF obesity was identified in 67.7% (n = 251), and physical frailty was identified in 38.5% (n = 142). In a regression analysis for frailty, sarcopenic TBF obesity presented an odds ratio of 6.88 (95% confidence interval 2.60-18.24; p < 0.001). Conclusion: In older Brazilian adults, sarcopenic obesity diagnosed by TBF obesity has a robust association with frailty and is independent of body mass index.

Chronic diseases, chest computed tomography, and laboratory tests as predictors of severe respiratory failure and death in elderly Brazilian patients hospitalized with COVID-19: a prospective cohort study.

BACKGROUND: The primary risk factors for severe respiratory failure and death in the elderly hospitalized with COVID-19 remain unclear. OBJECTIVE: To determine the association of chronic diseases, chest computed tomography (CT), and laboratory tests with severe respiratory failure and mortality in older adults hospitalized with COVID-19. METHOD: This was a prospective cohort with 201 hospitalized older adults with COVID-19. Chronic diseases, chest CT, laboratory tests, and other data were collected within the first 48 h of hospitalization. Outcomes were progression to severe respiratory failure with the need of mechanical ventilation (SRF/MV) and death. RESULTS: The mean age was 72.7 ± 9.2 years, and 63.2% were men. SRF/MV occurred in 16.9% (p < 0.001), and death occurred in 8%. In the adjusted regression analyses, lung involvement over 50% [odds ratio (OR): 3.09 (1.03-9.28; 0.043)], C-reactive protein (CRP) > 80 ng/mL [OR: 2.97 (0.99-8.93; 0.052)], Vitamin D < 40 ng/mL [OR: 6.41 (1.21-33.88; 0.029)], and hemoglobin < 12 g/mL [OR: 3.32 (1.20-9.20; 0.020)] were independent predictors for SFR/MV, while chronic atrial fibrillation [OR: 26.72 (3.87-184.11; 0.001)], cancer history [OR:8.32 (1.28-53.91; 0.026)] and IL-6 > 40 pg/mL [OR:10.01 (1.66-60.13; 0.012)] were independent predictors of death. CONCLUSION: In hospitalized older adults with COVID-19, tomographic pulmonary involvement > 50%, anemia, vitamin D below 40 ng/mL, and CRP above 80 mg/L were independent risk factors for progression to SRF/MV. The presence of chronic atrial fibrillation, previous cancer, IL-6 > 40 pg/mL, and anemia were independent predictors of death.

Measuring forearm bone density instead of lumbar spine bone density improves the sensitivity of diagnosing osteoporosis in older adults with cardiovascular diseases: Data from SARCOS study.

INTRODUCTION: In older individuals with cardiovascular diseases, it has been challenging to diagnose osteoporosis due to aortic calcification and degenerative processes in the spine of older adults, especially in very old adults. AIM: To assess whether the distal forearm BMD with the proximal femur BMD has greater sensitivity for the diagnosis of osteoporosis than the lumbar spine BMD with the proximal femur BMD. METHODS: We evaluated 515 older adults with cardiovascular disease from the SARCOS study and stratified them into under and over 80-year-old age groups and according to gender. Two diagnostic criteria were used to assess osteoporosis, SPF (lumbar spine and proximal femur BMD) and DFF (distal forearm and proximal femur BMD), which were compared with the multiple bone sites (MS) criteria (lumbar spine, distal radius, femoral neck, and total femur BMD). RESULTS: 43.9% were aged ≥80 years. Osteoporosis by SPF was diagnosed in 34% (n = 175), by DFF in 42.2% (n = 216), and by MS in 46.8% (n = 241). The characteristics of the three groups were similar. For every 100 older individuals with osteoporosis based on MS, 27 were not diagnosed by the SPF, and nine were not diagnosed by DFF (p = 0.001). The SPF did not diagnose osteoporosis in 23/100 in older adults aged <80 years, while DFF did not diagnose 16/100 (p.ns). In adults aged ≥80 years, the SPF did not identify osteoporosis in 31/100 older adults, while the DFF failed to identify it in only 5/100 (p < 0.001). In men and women aged ≥80 years, DFF showed higher sensitivity for the diagnosis of osteoporosis compared to the SPF criterion. CONCLUSION: In the elderly population with cardiovascular disease evaluated in our study, the use of distal forearm BMD instead of lumbar spine BMD, associated with proximal femur BMD, showed higher sensitivity for the diagnosis of osteoporosis, regardless of gender, and especially among the very older adults.

The association between low lean mass and osteoporosis increases the risk of weakness, poor physical performance and frailty in Brazilian older adults: data from SARCOS study.

PURPOSE: To characterize the phenotypes of older adults with low lean mass and osteoporosis, concomitantly or isolated, in regards to poor physical performance and frailty status. DESIGN: Cross-sectional analysis of the SARCopenia and OSteoporosis in Older Adults with Cardiovascular Diseases Study (SARCOS). SETTING: Outpatient geriatric cardiology clinic. PARTICIPANTS AND METHOD: 385 older adults underwent DXA analysis. Low lean mass was diagnosed according to FNIH and low BMD by a T-score ≤ -2.5 SD. Subjects were grouped into: I-Low lean mass and Osteoporosis (LLMO); II-Low lean mass (LLM); III-Osteoporosis (OP), and IV-Controls. Poor physical performance was diagnosed by weakness or slow walking speed or impaired mobility. Frailty was diagnosed by CHS criteria. RESULTS: The mean age was 78.22 ± 7.16 years. The prevalence of LLMO, LLM, and OP were 14.8%, 39.5%, and 19.2%, respectively. LLMO subjects were older, predominantly women, with a high percentage of body fat (HTBF). LLM was represented by obese men, while individuals with OP were preferably women, older and leaner. In a regression analyses, LLMO presented an OR: 6.42 (2.63‒15.65; p < 0.001) for weakness, OR: 2.55 (1.09‒5.95; p = 0.030) for impaired mobility, and OR: 14.75 (2.72‒79.94; p = 0.002) for frailty. After adjusting for HTBF, the OR for frailty, decreased to 7.25 (1.11-47.21; p = 0.038). LLM and OP were associated only with weakness with an OR: 3.06 (1.36-6.84; p = 0.006) and OR: 3.14 (1.29-7.62; p = 0.011), respectively. CONCLUSION: In Brazilian older community-dwelling outpatient adults, the phenotype characterized by low lean mass and osteoporosis presents a higher association with impaired mobility, weakness and frailty status compared to the others phenotyeps and controls. A high percentage of body fat presents a synergistic effect with low lean mass and osteoporosis phenotype in regards to frailty.

Extensive CFTR sequencing through NGS in Brazilian individuals with cystic fibrosis: unravelling regional discrepancies in the country.

BACKGROUND: The Brazilian population has a tri-hybrid composition with a high degree of ethnic admixture. We hypothesized that Brazilian individuals with CF from different Brazilian regions have a specific distribution of CFTR variants. METHODS: Individuals with CF with data available in the Patient Registry and without an established genotype were submitted to CFTR sequencing by Next Generation Sequencing (NGS) methodology, and results were anonymously incorporated to the Registry Database. Genotyping results were expressed as 'positive', 'inconclusive' or 'negative'. Logistic regression models were performed to investigate the association between demographic/clinical variables and genotyping results. Mediation analysis was conducted to estimate direct and indirect effects of Brazilian region on a binary positive genotyping response. RESULTS: In October 2017, data from 4,654 individuals with CF were available, and 3,104(66.7%) of them had a genotyping result. A total of 236 variants (114 new variants) were identified, with F508del identified in 46% of the alleles tested. Genotyping revealed 2,002(64.5%) individuals positive, 757(24.4%) inconclusive and 345(11.1%) negative. Distribution of genotype categories was markedly different across Brazilian Regions, with greater proportions of negative individuals in the North (45%) and Northeast (26%) regions. Newborn screening (CF-NBS) and age at diagnosis were identified as mediators of the effect of Brazilian region on a positive genotyping result. CONCLUSIONS: This large initiative of CFTR genotyping showed significant regional discrepancies in Brazil, probably related to socio-economic conditions, lack of adequate CF-NBS and poor access to reliable sweat testing. These results may be useful to indicate Regions where CF care demands more attention.

Sex effects on the association between sarcopenia EWGSOP and osteoporosis in outpatient older adults: data from the SARCOS study

ABSTRACT Objective: The objective was to evaluate the association between sarcopenia (EWGSOP) and osteoporosis in older adults. Subjects and methods: This is a cross sectional analysis of a baseline evaluation of the SARCopenia and OSteoporosis in Older Adults with Cardiovascular Diseases Study (SARCOS). Three hundred and thirty-two subjects over 65 years of age were evaluated. Sarcopenia was determined by EWGSOP flowchart and Osteoporosis was established by WHO's criteria. Physical function, comorbidities and medications were evaluated. Results: Women were older (79.8 ± 7.2 years) than men (78.21 ± 6.7 years) (p = 0.042). Osteoporosis occurred in 24.8% of men, and in 42.7% of women (p < 0.001); sarcopenia occurred in 25.5% of men and in 17.7%, of women (p = 0.103). Osteoporosis was diagnosed in 68% of sarcopenic women, however only 20.7% (p = 0.009) of women with osteoporosis had sarcopenia; in older men, 44.7% of individuals with sarcopenia presented osteoporosis and 42.9% (p = 0.013) of men with osteoporosis showed sarcopenia. In an adjusted logistic regression analyses for sarcopenia, osteoporosis presented a statistically significant association with sarcopenia in men [OR: 2.930 (95% CI: 1.044-8.237; p = 0.041)] but not in women [OR: 2.081 (0.787-5.5; p = 0.142)]; in the adjusted logistic regression analyses for osteoporosis, a statistically significant association occurred in men [OR: 2.984 (95% CI: 1.144-7.809; p = 0.025)], but not in women [OR: 2.093 (0.962-3.714; p = 0.137)]. Conclusion: According to sex, there are significant differences in the association between sarcopenia EWGSOP and osteoporosis in outpatient older adults. It is strong and significant in males; in females, despite showing a positive trend, it was not statistically significant.

Profile of medical students in the first group of the Faculdade Israelita de Ciências da Saúde Albert Einstein.

OBJECTIVE: To describe first medical students' profile of the Faculdade Israelita de Ciências da Saúde Albert Einstein. METHODS: Data were collected using an electronic questionnaire during the Biostatistics course in August of 2016. The students were inquired about demographic characteristics, data on their secondary education and college entrance exams, practice of physical exercise, leisure activities done, to have a physician in the family, and specialty that they intended to pursue as a career. RESULTS: Most of the students were women aged 18 to 21 years and who were originally from the state of São Paulo, had received secondary education in a private school, took a course to prepare for college entrance exam, and participated in more than 5 college entrance exams in the same year they entered in the School of Medicine. The majority of participants practiced physical exercise regularly and were engaged in common leisure activities. Most of students (58%) had a physician in the family and more than half (52%) did not know which specialty to pursue as career. There was no association between relationship with a physician and the student's choice of a specialty (p=0.390). CONCLUSION: Although it was the first group of student of School of Medicine at Faculdade Israelita de Ciências da Saúde Albert Einstein who took a different admission process, our data showed that students' profile is similar to students from other colleges.

Fragilidade é um preditor independente de morte precoce em idosos ambulatoriais com doenças cardiovasculares no Estudo SARCOS / Frailty is an independen t predictor of early death in elderly outpatients with cardiovascular disease in the SARCOS Study

Introdução: A fragilidade caracteriza-se pela perda da capacidade biológica e física de responder adequadamente ao estresse orgânico devido aos danos a diversos sistemas associados ao processo de envelhecimento. Entre os indivíduos com doenças cardiovasculares, a frequência da fragilidade é três vezes maior. Métodos: SARCOS é um estudo epidemiológico de coorte para avaliar a síndrome de vulnerabilidade com hospitalização e mortalidade em idosos ambulatoriais com doença cardiovascular (DCV). A fragilidade foi diagnosticada na presença de três ou mais dos seguintes critérios: perda de peso > 5%, velocidade de marcha reduzida, fraqueza muscular pela força de preensão, exaustão e perda de energia (levantar e sentar da cadeira cinco vezes). Resultados: Dos 169 pacientes avaliados, a fragilidade ocorreu em 19,5% (n=33). A média de idade foi de 78,3 ± 7,1 anos. A taxa mortalidade aos seis meses foi de 3% (n=5), sendo que 80% (n=4) eram frágeis e 20% (n=1) pré-frágeis (p=0,007). Na análise de regressão logística, a fragilidade mostrou ser um forte preditor de morte aos seis meses, com aumento de risco de 18 vezes quando comparado aos fortes (p=0,010), enquanto que entre as DCVs, a insuficiência cardíaca apresentou aumento de risco de quatro vezes (p=0,061). No modelo de interação entre a fragilidade e as DCVs, não houve diferença significativa da fragilidade em relação ao risco de morte. Conclusão: A fragilidade é um importante fator de risco de morte precoce em idosos ambulatoriais, independente e superior às doenças cardiovasculares crônicas mais frequentes que acometem essa população. A síndrome da fragilidade não apresenta sinergia com doenças cardiovasculares crônicas em relação ao risco de morte

Introduction: Frailty is characterized by the loss of the biological and physical capacity to respond adequately to organic stress as a result of damage to various systems associated with aging. The frequency of frailty is three times higher among individuals with cardiovascular disease. Methods: SARCOS is an epidemiological cohort study to evaluate vulnerability syndrome with hospitalization and mortality in elderly patients with cardiovascular disease (CVD). Frailty was diagnosed when three or more of the following criteria were present: Weight loss > 5%, slow walking speed, muscle weakness by the hand-grip test, exhaustion, and loss of energy (by the five times sit-to-stand test). Results: Of the 169 patients evaluated, frailty was present in 19.5%(n = 33). The mean age was 78.3 ± 7.1 years. The mortality rate at six months was 3% (n = 5), with 80% (n = 4) being frail and 20% (n = 1) pre-frail (p = 0.007). In the logistic regression analysis, frailty was shown to be a strong predictor of death at six months, with an 18-fold increase in risk when compared to strong individuals (p = 0.010), whereas among those with CVD, the heart failure presented a 4-fold increase in risk (p = 0.061). In the interaction model between frailty and CVD, there were no significant differences in frailty in relation to the risk of death. Conclusion: Frailty is an important risk factor for early death among outpatients, independent of, and higher than the most frequent chronic cardiovascular diseases that affect this population. Frailty syndrome was not correlated with chronic cardiovascular diseases, in relation to the risk of death

Effect of blood thiamine concentrations on mortality: Influence of nutritional status.

OBJECTIVE: To test the hypothesis that low blood thiamine concentrations in malnourished critically ill children are associated with higher risk of 30-d mortality. METHODS: Prospective cohort study in 202 consecutively admitted children who had whole blood thiamine concentrations assessed on admission and on days 5 and 10 of intensive care unit (ICU) stay. The primary outcome variable was 30-d mortality. Mean blood thiamine concentrations within the first 10 d of ICU stay, age, sex, malnutrition, C-reactive protein concentration, Pediatric Index of Mortality 2 score, and severe sepsis/septic shock were the main potential exposure variables for outcome. RESULTS: Thiamine deficiency was detected in 61 patients within the first 10 d of ICU stay, 57 cases being diagnosed on admission and 4 new cases on the 5th d. C-reactive protein concentration during ICU stay was independently associated with decreased blood thiamine concentrations (P = 0.003). There was a significant statistical interaction between mean blood thiamine concentrations and malnutrition on the risk of 30-d mortality (P = 0.002). In an adjusted analysis, mean blood thiamine concentrations were associated with a decrease in the mortality risk in malnourished patients (odds ratio = 0.85; 95% confidence interval [CI]: 0.73-0.98; P = 0.029), whereas no effect was noted for well-nourished patients (odds ratio: 1.03; 95% CI: 0.94-1.13; P = 0.46). CONCLUSIONS: Blood thiamine concentration probably has a protective effect on the risk of 30-d mortality in malnourished patients but not in those who were well nourished.

Sex effects on the association between sarcopenia EWGSOP and osteoporosis in outpatient older adults: data from the SARCOS study.

OBJECTIVE: The objective was to evaluate the association between sarcopenia (EWGSOP) and osteoporosis in older adults. SUBJECTS AND METHODS: This is a cross sectional analysis of a baseline evaluation of the SARCopenia and OSteoporosis in Older Adults with Cardiovascular Diseases Study (SARCOS). Three hundred and thirty-two subjects over 65 years of age were evaluated. Sarcopenia was determined by EWGSOP flowchart and Osteoporosis was established by WHO's criteria. Physical function, comorbidities and medications were evaluated. RESULTS: Women were older (79.8 ± 7.2 years) than men (78.21 ± 6.7 years) (p = 0.042). Osteoporosis occurred in 24.8% of men, and in 42.7% of women (p < 0.001); sarcopenia occurred in 25.5% of men and in 17.7%, of women (p = 0.103). Osteoporosis was diagnosed in 68% of sarcopenic women, however only 20.7% (p = 0.009) of women with osteoporosis had sarcopenia; in older men, 44.7% of individuals with sarcopenia presented osteoporosis and 42.9% (p = 0.013) of men with osteoporosis showed sarcopenia. In an adjusted logistic regression analyses for sarcopenia, osteoporosis presented a statistically significant association with sarcopenia in men [OR: 2.930 (95% CI: 1.044-8.237; p = 0.041)] but not in women [OR: 2.081 (0.787-5.5; p = 0.142)]; in the adjusted logistic regression analyses for osteoporosis, a statistically significant association occurred in men [OR: 2.984 (95% CI: 1.144-7.809; p = 0.025)], but not in women [OR: 2.093 (0.962-3.714; p = 0.137)]. CONCLUSION: According to sex, there are significant differences in the association between sarcopenia EWGSOP and osteoporosis in outpatient older adults. It is strong and significant in males; in females, despite showing a positive trend, it was not statistically significant.

Profile of medical students in the first group of the Faculdade Israelita de Ciências da Saúde Albert Einstein / Perfil dos ingressantes na primeira turma de graduação em Medicina da Faculdade Israelita de Ciências da Saúde Albert Einstein

ABSTRACT Objective: To describe first medical students' profile of the Faculdade Israelita de Ciências da Saúde Albert Einstein. Methods: Data were collected using an electronic questionnaire during the Biostatistics course in August of 2016. The students were inquired about demographic characteristics, data on their secondary education and college entrance exams, practice of physical exercise, leisure activities done, to have a physician in the family, and specialty that they intended to pursue as a career. Results: Most of the students were women aged 18 to 21 years and who were originally from the state of São Paulo, had received secondary education in a private school, took a course to prepare for college entrance exam, and participated in more than 5 college entrance exams in the same year they entered in the School of Medicine. The majority of participants practiced physical exercise regularly and were engaged in common leisure activities. Most of students (58%) had a physician in the family and more than half (52%) did not know which specialty to pursue as career. There was no association between relationship with a physician and the student's choice of a specialty (p=0.390). Conclusion: Although it was the first group of student of School of Medicine at Faculdade Israelita de Ciências da Saúde Albert Einstein who took a different admission process, our data showed that students' profile is similar to students from other colleges.

RESUMO Objetivo: Descrever o perfil dos estudantes de Medicina ingressantes na primeira turma do curso de graduação em Medicina da Faculdade Israelita de Ciências da Saúde Albert Einstein. Métodos: Os dados foram coletados a partir de uma pesquisa realizada pela internet durante o curso de Bioestatística, em agosto de 2016. A pesquisa abordou características sociodemográficas, dados do ensino médio e dos vestibulares, prática de atividade física, lazer, parentesco médico e especialidade que pretendia seguir. Resultados: A maioria dos estudantes de Medicina era do sexo feminino, procedente do Estado de São Paulo, com idade entre 18 a 21 anos, estudou o Ensino Médio em escola particular, fez cursinho pré-vestibular e prestou mais de cinco vestibulares no ano de ingresso na faculdade. Em geral, realizavam atividade física regularmente e tinham atividades de lazer comuns à essa faixa etária. A maior parte (58%) tinha algum parentesco médico e mais da metade (52%) não sabia qual especialidade seguir. Não houve associação entre parentesco médico e escolha da especialidade (p = 0,390). Conclusão: Apesar de ser a primeira turma e de ter passado por um processo seletivo diferenciado, os dados mostraram que o perfil dos alunos era semelhante ao encontrado em outras faculdades.

First experience with multiple mini interview for medical school admission in Brazil: Does it work in a different cultural scenario?

PURPOSE: Evaluation of non-cognitive skills never has been used in Brazil. This study aims to evaluate Multiple Mini Interviews (MMI) in the admission process of a School of Medicine in São Paulo, Brazil. METHODS: The population of the study comprised 240 applicants summoned for the interviews, and 96 raters. MMI contributed to 25% of the applicants' final grade. Eight scenarios were created with the aim of evaluating different non-cognitive skills, each one had two raters. At the end of the interviews, the applicants and raters described their impressions about MMI. The reliability of the MMI was analyzed using the Theory of Generalization and Many-Facet Rasch Model (MFRM). RESULTS: The G-study showed that the general reliability of the process was satisfactory (coefficient G = 0.743). The MMI grades were not affected by the raters' profile, time of interview (p = 0.715), and randomization group (p = 0.353). The Rasch analysis showed that there was no misfitting effects or inconsistent stations or raters. A significant majority of the applicants (98%) and all the raters believed MMIs were important in selecting students with a more adequate profile to study medicine. CONCLUSIONS: The general reliability of the selection process was excellent, and it was fully accepted by the applicants and raters.

Factors associated with the implementation of programs for drug abuse prevention in schools.

OBJECTIVE: To analyze if characteristics of managers, schools, and curriculum are associated with the implementation of programs for drug abuse prevention in elementary and high schools. METHODS: Cross-sectional study, with random sample of 263 school managers. Data were collected between 2012 and 2013 by a program that sends forms via internet. A closed self-filling questionnaire was applied online. Statistical analysis included Chi-square tests and logistic regression models. The outcome variable was the presence of program for drug abuse prevention inserted in the daily life and educational program of the school. The explanatory variables were divided into: demographic data of the manager; characteristics of the school and of the curriculum; health education; and drug use in the school. RESULTS: We found that 42.5% (95%CI 36.1-49.1) of the evaluated schools had programs for drug abuse prevention. With the multiple logistic regression model, we observed that the more time the manager has worked with education, the chance of the school having a program increased at about 4.0%. Experimenting with innovative teaching techniques also increased at about six times the chance of the school developing a program for drug abuse prevention. The difficulties in the implementation of the programs were more present in state and municipal schools, when compared with private schools, due to, for instance: lack of teaching materials, lack of money, and competing demands for teaching other subjects. CONCLUSIONS: The implementation of programs for drug abuse prevention in the city of Sao Paulo is associated with the experience of the manager in education and with the teaching strategies of the school. OBJETIVO: Analisar se características dos dirigentes, das escolas e do currículo escolar estão associadas à implantação de programas de prevenção ao uso de drogas nas escolas do ciclo fundamental II e médio. MÉTODOS: Estudo transversal, com amostra aleatória sistemática de 263 dirigentes escolares. Os dados foram coletados nos anos de 2012 e 2013 por meio de um programa de envio de formulários pela internet. Aplicou-se questionário fechado, de autopreenchimento on-line. A análise estatística incluiu testes Qui-quadrado e modelos de regressão logística. A variável desfecho foi a presença de programa de prevenção ao uso de drogas inserido no cotidiano e no programa pedagógico da escola. As variáveis explicativas foram divididas em: dados demográficos do dirigente; características da escola e do currículo; educação em saúde; e consumo de drogas na escola. RESULTADOS: Constatou-se que 42,5% (IC95% 36,1-49,1) das escolas avaliadas possuíam programa de prevenção ao uso de drogas. Com o modelo de regressão logística múltipla, observou-se que, a cada ano de atuação do dirigente na educação, a chance de a escola ter um programa aumentava em aproximadamente 4,0%. O fato de experimentar técnicas de ensino inovadoras também aumentou em cerca de seis vezes a chance de a escola desenvolver um programa de prevenção ao uso de drogas. As dificuldades na implantação dos programas foram mais presentes nas redes estadual e municipal, quando comparadas à rede privada, destacando-se: a falta de material didático, a falta de dinheiro e as demandas concorrentes para ensino de outras disciplinas. CONCLUSÕES: A implantação de programas de prevenção ao uso de drogas no município de São Paulo está associada à experiência do dirigente escolar na educação e nas estratégias de ensino da escola.

Micronutrient Deficiencies and Plasmodium vivax Malaria among Children in the Brazilian Amazon.

BACKGROUND: There is a growing body of evidence linking micronutrient deficiencies and malaria incidence arising mostly from P. falciparum endemic areas. We assessed the impact of micronutrient deficiencies on malaria incidence and vice versa in the Brazilian state of Amazonas. METHODOLOGY/PRINCIPAL FINDINGS: We evaluated children <10 years old living in rural communities in the state of Amazonas, Brazil, from May 2010 to May 2011. All children were assessed for sociodemographic, anthropometric and laboratory parameters, including vitamin A, beta-carotene, zinc and iron serum levels at the beginning of the study (May 2010) and one year later (May 2011). Children were followed in between using passive surveillance for detection of symptomatic malaria. Those living in the study area at the completion of the observation period were reassessed for micronutrient levels. Univariate Cox-proportional Hazards models were used to assess whether micronutrient deficiencies had an impact on time to first P. vivax malaria episode. We included 95 children median age 4.8 years (interquartile range [IQR]: 2.3-6.6), mostly males (60.0%) and with high maternal illiteracy (72.6%). Vitamin A deficiencies were found in 36% of children, beta-carotene deficiency in 63%, zinc deficiency in 61% and iron deficiency in 51%. Most children (80%) had at least one intestinal parasite. During follow-up, 16 cases of vivax malaria were diagnosed amongst 13 individuals. Micronutrient deficiencies were not associated with increased malaria incidence: vitamin A deficiency [Hazard ratio (HR): 1.51; P-value: 0.45]; beta-carotene [HR: 0.47; P-value: 0.19]; zinc [HR: 1.41; P-value: 0.57] and iron [HR: 2.31; P-value: 0.16]). Upon reevaluation, children with al least one episode of malaria did not present significant changes in micronutrient levels. CONCLUSION: Micronutrient serum levels were not associated with a higher malaria incidence nor the malaria episode influenced micronutrient levels. Future studies targeting larger populations to assess micronutrients levels in P. vivax endemic areas are warranted in order to validate these results.

Factors associated with the implementation of programs for drug abuse prevention in schools / Fatores associados à implantação de programas de prevenção ao uso de drogas nas escolas

ABSTRACT OBJECTIVE To analyze if characteristics of managers, schools, and curriculum are associated with the implementation of programs for drug abuse prevention in elementary and high schools. METHODS Cross-sectional study, with random sample of 263 school managers. Data were collected between 2012 and 2013 by a program that sends forms via internet. A closed self-filling questionnaire was applied online. Statistical analysis included Chi-square tests and logistic regression models. The outcome variable was the presence of program for drug abuse prevention inserted in the daily life and educational program of the school. The explanatory variables were divided into: demographic data of the manager; characteristics of the school and of the curriculum; health education; and drug use in the school. RESULTS We found that 42.5% (95%CI 36.1-49.1) of the evaluated schools had programs for drug abuse prevention. With the multiple logistic regression model, we observed that the more time the manager has worked with education, the chance of the school having a program increased at about 4.0%. Experimenting with innovative teaching techniques also increased at about six times the chance of the school developing a program for drug abuse prevention. The difficulties in the implementation of the programs were more present in state and municipal schools, when compared with private schools, due to, for instance: lack of teaching materials, lack of money, and competing demands for teaching other subjects. CONCLUSIONS The implementation of programs for drug abuse prevention in the city of Sao Paulo is associated with the experience of the manager in education and with the teaching strategies of the school.

RESUMO OBJETIVO Analisar se características dos dirigentes, das escolas e do currículo escolar estão associadas à implantação de programas de prevenção ao uso de drogas nas escolas do ciclo fundamental II e médio. MÉTODOS Estudo transversal, com amostra aleatória sistemática de 263 dirigentes escolares. Os dados foram coletados nos anos de 2012 e 2013 por meio de um programa de envio de formulários pela internet. Aplicou-se questionário fechado, de autopreenchimento on-line. A análise estatística incluiu testes Qui-quadrado e modelos de regressão logística. A variável desfecho foi a presença de programa de prevenção ao uso de drogas inserido no cotidiano e no programa pedagógico da escola. As variáveis explicativas foram divididas em: dados demográficos do dirigente; características da escola e do currículo; educação em saúde; e consumo de drogas na escola. RESULTADOS Constatou-se que 42,5% (IC95% 36,1-49,1) das escolas avaliadas possuíam programa de prevenção ao uso de drogas. Com o modelo de regressão logística múltipla, observou-se que, a cada ano de atuação do dirigente na educação, a chance de a escola ter um programa aumentava em aproximadamente 4,0%. O fato de experimentar técnicas de ensino inovadoras também aumentou em cerca de seis vezes a chance de a escola desenvolver um programa de prevenção ao uso de drogas. As dificuldades na implantação dos programas foram mais presentes nas redes estadual e municipal, quando comparadas à rede privada, destacando-se: a falta de material didático, a falta de dinheiro e as demandas concorrentes para ensino de outras disciplinas. CONCLUSÕES A implantação de programas de prevenção ao uso de drogas no município de São Paulo está associada à experiência do dirigente escolar na educação e nas estratégias de ensino da escola.

Gender Differences in Predrinking Behavior Among Nightclubs' Patrons.

BACKGROUND: Drinking before entering nightclubs (predrinking) seems to be associated with an increase in alcohol-related harm. This study aims to investigate gender differences in predrinking behavior and to evaluate its association with risk behaviors practiced inside nightclubs. METHODS: Individual-level data were collected by a portal survey of 2,422 patrons at the entrance and 1,833 patrons at the exit of 31 nightclubs located at São Paulo, Brazil. The nightclubs were selected by 2-stage sampling with probability proportional to the establishments' capacity in the first stage and a systematic sample of patrons in the entrance line in the second stage. Breath alcohol concentration (BrAC) was measured at the entrance and exit. Face-to-face interviews identified predrinking characteristics and risk behaviors. Weighted analyses were stratified by gender. RESULTS: Predrinking was practiced by 49.2% (95% confidence interval [CI] = 42.7 to 55.8) of the male patrons and 29.0% (95% CI = 20.6 to 38.9) of the female patrons (p < 0.001) on the day of the interview. When considering only predrinkers, men and women showed similar BrAC at entrance and exit and similar proportion of alcoholic intoxication (BrAC ≥ 0.38 mg/l). In both genders, people who practiced predrinking on the day of the interview were more likely to drink inside the nightclub, compared to those who did not practice predrinking (p < 0.001). Among men, the practice of predrinking increased the chance of "drinking and driving" after leaving the nightclub (odds ratio [OR] = 6.9, 95% CI = 4.1-11.5, p < 0.001). Among women, the practice of predrinking increased the chances of experiencing sexual harassment in the nightclub (OR = 2.9, 95% CI = 1.3 to 6.6, p = 0.010). CONCLUSIONS: Predrinking is more prevalent among men; however, men and women who engaged in predrinking have a similar pattern of alcohol consumption and exit BrAC. The fact that risk behaviors and illicit drug use were associated with predrinking but differ between genders suggests that a gender-specific approach should be used in tailored interventions to prevent alcohol-related harm in nightclubs.

Frailty predictors and outcomes among older patients with cardiovascular disease: Data from Fragicor.

The aim of this study was to evaluate predictive factors for frailty among older outpatient adults with cardiovascular disease (CVD) and to assess the predictive value of frailty in regard to mortality, disability and hospitalization at 1-year follow-up. A prospective cohort study was carried out with subjects over 65 years of age from an outpatient Cardiology clinic, with at least one CVD. At baseline, we classified frailty as proposed by Fried, i.e.; unintentional weight loss (10lbs in the past year), self-reported exhaustion, weakness (measured by grip strength), slow walking speed, and low physical activity. A frail person was defined by the presence of three or more criteria, prefrail by one or two and robust by the absence of them. Disability, previous hospitalizations, falls, morphometric and socio-demographic variables were collected; as well as the presence of CVD and hemodynamic parameters (HP): systolic (SPB) and diastolic blood pressure (DBP), heart rate (HR) and ejection fraction (EF). At 1-year follow-up, the outcomes assessed were: disability, number of hospitalizations and death. 172 subjects were included in this study with a mean age of 77 years old. The prevalence of frail was 39.8%, prefrail 51.5% and robust was 8.7%. Among the CVD and HP evaluated, myocardial infarction (MI), presence of three or more CVDs, lower SPB and DBP were significant and independent factors associated with the frailty phenotype. At 1-year follow up, frailty was an independent predictor for disability (Odds Ratio (OR): 3.94 (1.59-9.75); p=0.003) and it increased death probability by three times if compared to the robust group. In conclusion, older outpatients with CVD have a higher probability to be frail than older adults who do not have a CVD. Low SPB and DBP must always be taken into consideration due to their high association with frailty. It is also important to diagnose frailty in this population due to the high association with mortality and disability.