The impact of a physical exercise program on quality of life, fatigue, physical performance, and level of physical activity in patients with cancer.

OBJECTIVE: Increasing evidence suggests that exercise programs are of great value in the rehabilitation and survivorship of patients with cancer. However, challenges remain regarding maintaining patients more physically active. This study aimed to evaluate the impact of a supervised exercise program on quality of life, fatigue, physical performance, and levels of physical activity of patients with cancer. METHODS: An observational longitudinal study, with a 1-year prospective follow-up, was developed. SETTING: This is a university-based outpatient rehabilitation program in a high-complexity cancer care center in Sao Paulo. RESULTS: After the program, patients showed a significant gain in quality of life (p<0.0001), physical performance (p<0.0001), and improvement in fatigue (p<0.0001). After 12 months, 81.1% of the patients remained active, and only 4.5% declared themselves to be sedentary. CONCLUSION: The results of this study confirm that exercise programs are an important tool in the rehabilitation of patients with cancer and that an initial supervised exercise program, in combination with follow-ups, can help increase the levels of physical activity of this population. CLINICAL REHABILITATION IMPACT: This study provides additional information on the outcomes that are expected with the provision of a supervised physical exercise program in the rehabilitation care of patients with cancer and that additional follow-ups could further benefit this population.

The impact of a physical exercise program on quality of life, fatigue, physical performance, and level of physical activity in patients with cancer

SUMMARY OBJECTIVE: Increasing evidence suggests that exercise programs are of great value in the rehabilitation and survivorship of patients with cancer. However, challenges remain regarding maintaining patients more physically active. This study aimed to evaluate the impact of a supervised exercise program on quality of life, fatigue, physical performance, and levels of physical activity of patients with cancer. METHODS: An observational longitudinal study, with a 1-year prospective follow-up, was developed. SETTING: This is a university-based outpatient rehabilitation program in a high-complexity cancer care center in Sao Paulo. RESULTS: After the program, patients showed a significant gain in quality of life (p<0.0001), physical performance (p<0.0001), and improvement in fatigue (p<0.0001). After 12 months, 81.1% of the patients remained active, and only 4.5% declared themselves to be sedentary. CONCLUSION: The results of this study confirm that exercise programs are an important tool in the rehabilitation of patients with cancer and that an initial supervised exercise program, in combination with follow-ups, can help increase the levels of physical activity of this population. CLINICAL REHABILITATION IMPACT: This study provides additional information on the outcomes that are expected with the provision of a supervised physical exercise program in the rehabilitation care of patients with cancer and that additional follow-ups could further benefit this population.

Análise de custo de sequência de tratamento de câncer de ovário avançado, HRD/ BRCAwt, sob a perspectiva do sistema de saúde suplementar brasileiro / Cost Analysis of advanced ovarian cancer treatment sequence, HRD/BRCAwt from the Brazilian supplementary healthcare system perspective

Objetivo: Estimar o custo da sequência de tratamento considerando as terapias com niraparibe e bevacizumabe, respectivamente, como terapias de manutenção de 1L e 2L para pacientes com câncer de ovário (CO) epitelial com deficiência de recombinação homóloga (HRD) e BRCA selvagem (BRCAwt) em um horizonte temporal de cinco anos, sob a perspectiva do sistema de saúde suplementar brasileiro. Métodos: Foi desenvolvido um modelo de sobrevida particionado com três transições de estados de saúde, considerando os seguintes regimes em 1L e 2L, respectivamente: carboplatina + paclitaxel seguido de terapia de manutenção com niraparibe; carboplatina + gencitabina + bevacizumabe seguido pela continuação de bevacizumabe. As posologias em bula e as curvas de sobrevida livre de progressão dos respectivos estudos pivotais em cada uma das linhas terapêuticas foram utilizadas na análise, e o custo de tratamento foi calculado a partir da lista oficial de preços de medicamentos da CMED de abril de 2023. Resultados: O custo em 1L e 2L foi de BRL 868.830 e BRL 403.407, totalizando BRL 1.272.237 em um horizonte temporal de cinco anos, com 2,28 e 0,52 anos de vida livre de progressão, respectivamente, na 1L e 2L, com o total de 2,8 anos. Conclusões: O resultado da análise de custo de sequência de tratamento de câncer de ovário HRD/BRCAwt apresentou um custo total estimado de BRL 1.272.237, com 2,8 anos de vida livre de progressão. Essa análise contribui no entendimento dos custos e da eficácia esperada com o uso da terapia de manutenção de niraparibe em 1L e bevacizumabe em 2L em um horizonte temporal de cinco anos.

Objective: To estimate the cost of the treatment sequence, considering the maintenance therapies niraparib and bevacizumab, respectively, as maintenance therapies in 1L and 2L for patients with epithelial ovarian cancer with homologous recombination deficiency (HRD) and BRCA wild-type (BRCAwt) over a 5-year time horizon from the perspective of the Brazilian supplementary health system. Methods: A partitioned survival model was developed with three health state transitions, considering the following regimens in the 1L and 2L, respectively: carboplatin + paclitaxel followed by maintenance therapy with niraparib; carboplatin + gemcitabine + bevacizumab followed by the continuation of bevacizumab. The product's label and progression-free survival curves from the respective pivotal studies in each of the therapeutic lines were used in the analysis and the cost of treatment was calculated using as a reference the official CMED drug price list from April 2023. Results: The cost in 1L and 2L was BRL 868,830 and BRL 403,407, totaling BRL 1,272,237 over a 5-year period, with 2.28 and 0.52 years of progression-free survival, respectively in 1L and 2L, with a total of 2.8 years. Conclusions: The result of the analysis of the cost of the treatment sequence of ovarian cancer HRD/BRCAwt presented an estimated total cost of 1,272,237 with 2.8 year of progression-free survival. This analysis contributes to understand the expected cost and effectiveness with the use of maintenance therapy niraparib in 1L and bevacizumab in 2L over a 5-year time horizon.

Obstetric simulation for undergraduate medical education: how to improve students' self-confidence and expectation according to gender.

OBJECTIVE: The aim of this study was to evaluate the effects of obstetric simulation training on undergraduate medical students to improve their self-confidence. METHODS: Fifth-year undergraduate medical students were invited to a 2-week course of simulation in obstetrics during their clerkship. The sessions included were as follows: (1) care for the second and third periods of childbirth, (2) partograph analysis and pelvimetry, (3) premature rupture of membranes at term, and (4) diagnosis and management of third-trimester bleeding. Before the first session and at the end of the training period, a questionnaire about self-confidence in obstetric procedures and skills was applied. RESULTS: A total of 115 medical students were included, of whom 60 (52.2%) were male and 55 (47.8%) were female. Comparing initial and final scores, the median results of the subscales "comprehension and preparation" (18 vs. 22, p<0.001), "knowledge of procedures" (14 vs. 20, p<0.001), and "expectation" (22 vs. 23, p<0.01) were significantly higher at the end of the training period in all items of the questionnaire than in the beginning. Differences were found based on the students' gender, i.e., female students had a significantly higher sum of scores than the male students in the initial subscale for "expectation" (median, 24 vs. 22, p<0.001) and "interest" (median, 23 vs. 21, p=0.032), and a higher sum of scores in the subscale for "expectation" (median, 23 vs. 21, p=0.010) in the final questionnaire. CONCLUSION: Obstetric simulation enhances the improvement of students' self-confidence in understanding both the physiology of childbirth and the obstetric care procedures. Further studies are needed to understand the influence of gender on obstetric care.

Solutions Containing a Statherin-Derived Peptide Reduce Enamel Erosion in vitro.

The effect of solutions containing a statherin-derived peptide (Stn15pSpS) on the protection against enamel erosion in vitro was evaluated. Bovine enamel specimens were divided into 4 groups (n = 15/group): (1) deionized water (negative control), (2) Elmex Erosion Protection™ (positive control), (3) 1.88 × 10-5 M Stn15pSpS, and (4) 3.76 × 10-5 M Stn15pSpS. The solutions were applied on the specimens for 1 min. Stimulated saliva was collected from 3 donors and used to form a 2-h acquired pellicle on the specimens. Then, the specimens were submitted to an erosive pH-cycling protocol 4 times/day, for 7 days (0.01 M HCl pH 2.0/45 s, artificial saliva/2 h, and artificial saliva overnight). The solutions were applied again during pH-cycling, 2 times/day for 1 min after the first and last erosive challenges. Enamel loss (µm) was assessed by contact profilometry. Data were analyzed by Kruskal-Wallis and Dunn's test (p < 0.05). The best protection against erosion was conferred by Elmex Erosion Protection that significantly differed from all the other treatments, followed by the solutions containing Stn15pSpS, regardless of the concentration. However, 3.76 × 10-5 M Stn15pSpS did not differ from the negative control. The solution containing the lower concentration of Stn15pSpS protected against erosion in vitro, which should be confirmed using protocols that more closely resemble the clinical condition.

Obstetric simulation for undergraduate medical education: how to improve students' self-confidence and expectation according to gender

SUMMARY OBJECTIVE: The aim of this study was to evaluate the effects of obstetric simulation training on undergraduate medical students to improve their self-confidence. METHODS: Fifth-year undergraduate medical students were invited to a 2-week course of simulation in obstetrics during their clerkship. The sessions included were as follows: (1) care for the second and third periods of childbirth, (2) partograph analysis and pelvimetry, (3) premature rupture of membranes at term, and (4) diagnosis and management of third-trimester bleeding. Before the first session and at the end of the training period, a questionnaire about self-confidence in obstetric procedures and skills was applied. RESULTS: A total of 115 medical students were included, of whom 60 (52.2%) were male and 55 (47.8%) were female. Comparing initial and final scores, the median results of the subscales "comprehension and preparation" (18 vs. 22, p<0.001), "knowledge of procedures" (14 vs. 20, p<0.001), and "expectation" (22 vs. 23, p<0.01) were significantly higher at the end of the training period in all items of the questionnaire than in the beginning. Differences were found based on the students' gender, i.e., female students had a significantly higher sum of scores than the male students in the initial subscale for "expectation" (median, 24 vs. 22, p<0.001) and "interest" (median, 23 vs. 21, p=0.032), and a higher sum of scores in the subscale for "expectation" (median, 23 vs. 21, p=0.010) in the final questionnaire. CONCLUSION: Obstetric simulation enhances the improvement of students' self-confidence in understanding both the physiology of childbirth and the obstetric care procedures. Further studies are needed to understand the influence of gender on obstetric care.

Cancer and occupational exposure to pesticides: a bibliometric study of the past 10 years.

Occupational exposure to pesticides has been identified as a major trigger of the development of cancer. Pesticides can cause intoxication in the individuals who manipulate them through either inhalation, ingestion, or dermal contact. Given this, we investigated the association between the incidence of cancer and occupational exposure to pesticides through a bibliometric analysis of the studies published between 2011 and 2020, based on 62 papers selected from the Scopus database. The results indicated an exponential increase in the number of studies published over the past decade, with most of the research being conducted in the USA, France, India, and Brazil, although a further 17 nations were also involved in the research on the association between cancer and pesticides. The principal classes of pesticides investigated in relation to their role in intoxication and cancer were insecticides, herbicides, and fungicides. The types of cancer reported most frequently were multiple myeloma, bladder cancer, non-Hodgkin's lymphoma, prostate cancer, leukemia, and breast cancer. Despite the known association between pesticides and cancer, studies are still relatively scarce in comparison with the global scale of the use of these xenobiotic substances, which is related to the increasing demand for agricultural products throughout the world.

Solutions and Gels Containing a Sugarcane-Derived Cystatin (CaneCPI-5) Reduce Enamel and Dentin Erosion in vitro.

The effect of solutions and gels containing a sugarcane-derived cystatin (CaneCPI-5) on the protection against enamel and dentin erosion in vitro was evaluated. Bovine enamel and dentin specimens were divided into 2 groups (n = 135 and 153/group for enamel and dentin, respectively) that were treated with solutions or chitosan gels containing 0.1 or 0.25 mg/mL CaneCPI-5. The positive controls for solutions and gels were Elmex Erosion Protection™ solution and NaF gel (12,300 ppm F), respectively. Deionized water and chitosan gel served as controls, respectively. The solutions were first applied on the specimens for 1 min and the gels for 4 min. Stimulated saliva was collected from 3 donors and used to form a 2-h acquired pellicle on the specimens. Then, the specimens were submitted to an erosive pH cycling protocol 4 times/day for 7 days (0.1% citric acid pH 2.5/90 s, artificial saliva/2 h, and artificial saliva overnight). The solutions and gels were applied again during pH cycling, 2 times/day for 1 min and 4 min, respectively, after the first and last erosive challenges. Enamel and dentin losses (µm) were assessed by contact profilometry. Data were analyzed by 2-way ANOVA and Tukey's test (p < 0.05). All the treatments significantly reduced enamel and dentin loss in comparison with controls. Both CaneCPI-5 concentrations had a similar protective effect against enamel erosion, but only the higher concentration was as effective against dentin erosion as the positive control. Regarding the vehicles, only the 0.1 mg/mL gel performed worse than the positive control for dentin. CaneCPI-5 reduced enamel and dentin erosion to a similar extent as the fluoride-containing vehicles. However, dentin requires higher CaneCPI-5 concentrations, in the case of gels. Solutions or gels containing CaneCPI-5 might be a new approach to protect against dental erosion.

Effect of a sugarcane cystatin on the profile and viability of microcosm biofilm and on dentin demineralization.

To analyze the effect of a sugarcane cystatin (CaneCPI-5) on the microbial profile and viability, as well as on the prevention of dentin demineralization using a microcosm biofilm model. Ninety bovine dentine specimens were divided into five experimental groups according with the solution they were treated for 60 s: (1) PBS (negative control), (2) 0.12% chlorhexidine (positive control), (3) Fluoride (500 ppm F, as NaF), (4) 0.025 mg/ml CaneCPI-5, and (5) 0.05 mg/ml CaneCPI-5. Specimens were incubated with inoculum (McBain's saliva plus human saliva) in the first 8 h, and from then on, they were exposed to McBain saliva containing sucrose and daily treated (60 s) with the solutions for 5 days. Resazurin and colony-forming unit counting assays were performed. Dentin demineralization was measured by transverse micro-radiography (TMR). 0.12% chlorhexidine significantly reduced the metabolic activity of the microcosm biofilm in relation to the negative control and treated groups (p < 0.01). CHX and F significantly reduced the counts of total microorganisms, mutans group streptococci, and lactobacilli when compared with the negative control. None of the treatments was able to significantly reduce dentin demineralization in comparison with the negative control. In the model evaluated, CaneCPI-5 neither altered the microcosm biofilm profile and viability nor protected dentin against demineralization.

"a gente tem que somar": fontes de captação financeira de atletas da seleção brasileira de judô / "we have to add": funding sources for athletes of brazil's national judo team / "tenemos que sumar": fuentes de captación financiera de los deportistas de la selección brasileña de judo

Resumo O judô é um esporte em destaque no Brasil. Um dos motivos para isso é o suporte financeiro que o país oferta. Por conta disso, este trabalho objetivou descrever e analisar as formas de captação de recursos financeiros dos atletas de ponta do judô e detalhar a utilização do Programa Bolsa Atleta em suas carreiras. Foram entrevistados 17 atletas da seleção brasileira de judô. Geralmente, os atletas se beneficiam de quatro fontes de recursos financeiros - clube, patrocínios individuais, Programa de Atletas do Alto Rendimento (PAAR) e Programa Bolsa Atleta. Além disso, a Confederação Brasileira de Judô (CBJ) auxilia com outros recursos. Concluiu-se, então, que as principais fontes de financiamento dos atletas vêm do governo federal. É possível se manter financeiramente como atleta de alto rendimento, contudo, há um déficit no financiamento de judocas de base, falta de suporte para recuperação de lesões e para o pós-carreira do atleta.

Abstract Judo is a prominent sport in Brazil, partly as a result of government-provided financial support. This work describes and analyzes top judo athletes' fundraising strategies and the uses they make of the Athlete Scholarship Program in their careers. Seventeen athletes from Brazil's national judo team were interviewed. Athletes usually benefit from four funding sources - clubs, individual sponsors, the High-Performance Athletes Program (PAAR), and the Athlete Scholarship Program. In addition, the Brazilian Judo Confederation (CBJ) assists with other resources. The study concludes that the main funding sources for athletes are provided by the federal government. High performance athletes are able support themselves, but lower-level athletes are underfunded and lack support to recover from injuries and for their post-career times.

Resumen El judo es un deporte destacado en Brasil, y una de las razones de esto es el apoyo financiero que ofrece el país. Por eso, este trabajo tuvo como objetivo describir y analizar las formas de captación de recursos económicos de los deportistas de élite del judo, y detalla la utilización del Programa Bolsa Atleta (Beca Atleta) en sus carreras. Fueron entrevistados 17 deportistas de la selección brasileña de judo. Generalmente, los deportistas se benefician de cuatro fuentes de recursos financieros: club, patrocinios individuales, Programa de Atletas de Alto Rendimiento (PAAR) y Programa Bolsa-Atleta. Además, la Confederación Brasileña de Judo (CBJ) colabora con otros recursos. Se concluyó que las principales fuentes de financiación de los deportistas provienen del gobierno federal. Es posible mantenerse económicamente como deportista de alto rendimiento, sin embargo, existe un déficit en la financiación de los judokas de base, falta de apoyo para la recuperación de lesiones y para la poscarrera del deportista.

Judocas brasileiros: um panorama sobre os atletas contemplados pelo programa bolsa-atleta pódio entre os anos de 2013 e 2018 / Brazilian judokas: an overview of the athletes contemplated by the athlete scholarship podium program between 2013 and 2018 / Judokas brasileños: una descripción general de los atletas contemplados por el programa beca-atleta podio entre 2013 y 2018

Em 2004 o Governo Federal criou o Programa Bolsa-Atleta com quatro categorias de bolsa e, em 2013, acrescentou a Pódio. Esta tem como objetivo financiar atletas com chances de medalhas nos Jogos Olímpicos. Como o Judô foi a modalidade que mais trouxe medalhas para o Brasil nessa competição, este estudo analisou as variáveis de idade, sexo, naturalidade, local de treinamento e categoria de peso dos atletas de Judô beneficiados pelo Programa Bolsa-Atleta categoria Pódio entre 2013 e 2018. Os dados foram recolhidos através de uma pesquisa documental nas portarias que continham os nomes dos atletas contemplados pela Bolsa-Atleta Pódio, e uma pesquisa quantitativa para cruzar as variáveis. Observou-se que a distribuição de bolsas se deu de forma equilibrada entre homens e mulheres. Além disso, notou-se também que a maioria dos atletas de Judô nasceu na região Sudeste, mais especificamente no estado de São Paulo. Isso indica o investimento da região no esporte de base e de elite, tendo em vista que o maior centro de treinamento de alto rendimento se encontra no Sudeste.

In 2004 the Federal Government created the Bolsa-Atleta Program with four categories of scholarship and, in 2013, added Pódio. This aims to finance athletes with chances of medals at the Olympic Games. As Judo was the modality that most brought medals to Brazil in this competition, this study analyzed the variables of age, sex, place of training and weight category of Judo athletes benefited by the Bolsa-Athlete Program category Podium between 2013 and 2018. The data were collected through a documentary search in the ordinances that contained the names of the athletes contemplated by Bolsa-Atleta Pódio, and a quantitative research to cross the variables. It was observed that the distribution of scholarships took place in a balanced way between men and women. In addition, it was also noted that the majority of Judo athletes were born in the Southeast, more specifically in the state of São Paulo. This indicates the region's investment in basic and elite sports, given that the largest high-performance training center is in the Southeast.

En 2004, el Gobierno Federal creó el Programa Bolsa-Atleta con cuatro categorías de becas y, en 2013, agregó Pódio. Su objetivo es financiar a los atletas con posibilidades de medallas en los Juegos Olímpicos. Como el Judo fue la modalidad que más trajo medallas a Brasil en esta competencia, este estudio analizó las variables de edad, sexo, lugar de entrenamiento y categoría de peso de los atletas de Judo beneficiados por el podio de la categoría del Programa Bolsa-Atleta entre 2013 y 2018. Los datos se recopilaron a través de una búsqueda documental en las ordenanzas que contenían los nombres de los atletas contemplados por Bolsa-Atleta Pódio, y una investigación cuantitativa para cruzar las variables. Se observó que la distribución de las becas se realizaba de manera equilibrada entre hombres y mujeres. Además, también se observó que la mayoría de los atletas de judo nacieron en el sureste, más específicamente en el estado de São Paulo. Esto indica la inversión de la región en deportes básicos y de élite, dado que el centro de entrenamiento de alto rendimiento más grande se encuentra en el sureste.

Exosomes Could Offer New Options to Combat the Long-Term Complications Inflicted by Gestational Diabetes Mellitus.

Gestational diabetes Mellitus (GDM) is a complex clinical condition that promotes pelvic floor myopathy, thus predisposing sufferers to urinary incontinence (UI). GDM usually regresses after birth. Nonetheless, a GDM history is associated with higher risk of subsequently developing type 2 diabetes, cardiovascular diseases (CVD) and UI. Some aspects of the pathophysiology of GDM remain unclear and the associated pathologies (outcomes) are poorly addressed, simultaneously raising public health costs and diminishing women's quality of life. Exosomes are small extracellular vesicles produced and actively secreted by cells as part of their intercellular communication system. Exosomes are heterogenous in their cargo and depending on the cell sources and environment, they can mediate both pathogenetic and therapeutic functions. With the advancement in knowledge of exosomes, new perspectives have emerged to support the mechanistic understanding, prediction/diagnosis and ultimately, treatment of the post-GMD outcomes. Here, we will review recent advances in knowledge of the role of exosomes in GDM and related areas and discuss the possibilities for translating exosomes as therapeutic agents in the GDM clinical setting.

Germline Mutations in Familial Papillary Thyroid Cancer.

Thyroid cancer, predominantly of papillary histology (PTC), is a common cancer mostly diagnosed sporadically. Hereditary PTC is encountered in ~ 5% of cases and may present at an earlier age, with greater risks of metastasis and recurrence, compared with sporadic cases. The molecular basis of hereditary PTC is unknown in most cases. In this study, the genetic basis of hereditary PTC in three Brazilian families was investigated. Whole exome sequencing (WES) was carried out for probands in each family, and validated, pathogenic/likely pathogenic sequence variants (P/LPSVs) were genotyped in additional family members to establish their putative pathogenic role. Overall, seven P/LPSVs in seven novel genes were detected: p.D283N*ANXA3, p.Y157S*NTN4, p.G172W*SERPINA1, p.G188S*FKBP10, p.R937C*PLEKHG5, p.L32Q*P2RX5, and p.Q76*SAPCD1. These results indicate that these novel genes are seemingly associated with hereditary PTC, but extension and validation in other PTC families are required.

Aprendizagem Baseada em Problemas: Contribuição para Médicos Pediatras / Problem-Based Learning: Contribution to Pediatric Practice

RESUMO Introdução A Aprendizagem Baseada em Problemas (ABP) tem se destacado na educação médica por ser uma proposta fundamentada no construtivismo, com a finalidade de desenvolver a autonomia e o raciocínio crítico do estudante para tomada de decisões. Objetivo Por conta das dificuldades encontradas pelos graduandos e das escassas informações relativas à contribuição da ABP para a prática clínica de médicos pediatras, objetivou-se avaliar a contribuição da ABP para a formação dos médicos pediatras. Metodologia Trata-se de uma série de casos de abordagem descritiva, desenvolvida com médicos pediatras egressos de duas instituições públicas de ensino. A definição da amostra ocorreu de forma intencional, amostragem não probabilística, em que os atributos dos participantes são definidos conforme o objeto de estudo, a fim de selecionar quais os indivíduos são mais adequados para serem incluídos na amostra, a qual é composta por dez médicos pediatras, sendo cinco egressos de cada instituição. Para responderem ao questionário, selecionaram-se médicos especialistas em pediatria. A coleta de dados foi realizada pela pesquisadora principal, por meio de três questões semiestruturadas respondidas via e-mail. As respostas dos entrevistados às questões abertas foram analisadas pelo método de análise reflexão-síntese, que pressupõe a análise e síntese de conteúdo mediadas pela sensibilidade e pela razão. Resultados Os resultados obtidos entre 2003 e 2012 indicaram que 28% dos médicos pediatras apresentavam título de especialista e 72% não o tinham esse título. Os discursos apresentados pelos participantes permitiram identificar que a ABP contribuiu para a formação e atuação dos médicos pediatras em diferentes aspectos, proporcionando a busca de conhecimento, a habilidade para trabalhar em equipe e a facilidade para realizar o manejo clínico de forma interdisciplinar e holística. Porém, os discursos também demonstraram que esse método pode não favorecer o aprofundamento das matérias básicas. Conclusão A ABP contribuiu para a formação e atuação do médico pediatra, porém pode não ter favorecido o aprofundamento das matérias básicas.

ABSTRACT Introduction Problem-Based Learning (PBL) has been highlighted in medical education because it is a proposal based on constructivism, with the purpose of developing students' autonomy and critical thinking for decision-making. Objective In view of the difficulties experienced by undergraduate students and the scarce information regarding the contribution of PBL to the clinical practice of pediatric physicians, we aimed to evaluate the contribution of PBL to the training of pediatricians. Methods This is a series of descriptive cases, developed with pediatricians from two public educational institutions. This study used an intentional, non-probabilistic sampling technique, in which the attributes of the participants are defined according to the object of study, aiming to select which individuals are more suitable to be included in the sample, consisting of ten pediatricians, with five graduated from each institution. Pediatricians were selected to answer the questionnaire. Data collection was performed by the main researcher, through three semi-structured questions answered via e-mail. The interviewees' answers to the open questions were analyzed using the method of reflection-synthesis analysis, which presupposes content analysis and synthesis mediated by sensitivity and reason. Results The results indicated that 28% of the pediatricians had a Board Certification degree, and 72% did not, between the years 2003 and 2012. The participants' discourses allowed us to identify that the PBL contributed to the training and performance of pediatricians in different aspects, providing the search for knowledge; ability to work as a team; and capacity to conduct clinical management in an interdisciplinary and holistic way. However, the discourses also demonstrated that this method might not favor the developing of the basic subjects. Conclusion The PBL contributed to the training and performance of the pediatrician, but it might not have favored the developing of the basic subjects.

Avaliação da rotulagem de água sanitária, em relação à orientação sobre a sanitização de alimentos / Evaluation of bleaching agents labeling in relation to the guidance on the sanitization of food

Os riscos micrabianos que afetam a segurança dos alimentos podem estar presentes em qualquer etapa da cadeia de produção e, finalmente, à mesa do consumidor. O processo de sanitização é fundamental para que ocorra a redução dos micro-organismos indesejáveis, mas para que o mesmo possa ser eficiente, é imprescindível saber utilizar o sanitizante da maneira correta. Um sanitizante bastante utilizado em domicílios é o hipoclorito de sódio, sendo assim o presente trabalho teve o objetivo de analisar os rótulos de águas sanitárias e verificar se os mesmos correspondem às recomendações literárias e se estão redigidos de forma clara para o consumidor. Para fazer esta análise, foram adquiridas l7 marcas de água sanitária, em estabelecimentos comerciais de Belo Horizonte - MG, no ano de 2013. Com base na amostragem adquirida foram analisados e discutidos os resultados. Todas as marcas estavam redigidas de forma clara para o consumidor, mas apenas 23,52% apresentaram a descrição das etapas do processo de sanitização completas. Dessa forma observou-se que critérios para uma padronização das informações de sanitização de alimentos com hipoclorito de sódio devem ser definidos, a fim de facilitar ao máximo a compreensão do consumidor e propiciar os profissionais de saúde transmitirem uma orientação coerente para esta prática. (AU)

The microbial risks that affect the food safety can be present in any stage of the production process, and finally at the customer's table. The process of sanitation is fundamental so that can reduce the undesirable micro-organisms but in order to be efficient it's indispensable to know how to use the sanitizer correctly. The most used sanitizer at homes is the sodium hypochlorite, thus this work has the objective to analyze bleach 's labels and check (f there is a correspondence between the literary recommendation and if it's been written clearly for the customer. For the analyze it was acquired 17different brands of bleach in shops in Belo Horizonte - MG, in 2013. Based on the acquired sampling the results were analyzed and discussed. All brands were written clearly for the costumer, but only 23,52% presented the complete sanitization process description. Therefore it has been observed that standardization criteria for the food sanitization information with sodium hypochlorite should be defined so that facilitate the most the costumer comprehension and propitiate the health professionals to convey a coherent orientation about his practice. (AU)

Impact of two different exercise programs on persistent cancer-related fatigue and physical fitness / O impacto de dois diferentes programas de exercício físico na performance física e na fadiga relacionada ao câncer

A fadiga relacionada ao câncer é um dos sintomas mais comuns entre pacientes com câncer, relatada em 70% a 100% desses pacientes resultando em uma redução significativa da qualidade de vida, funcionalidade e independência. O exercício físico tem sido identificado como um elemento central de reabilitação de muitas doenças crônicas como câncer, e cada vez mais evidências apoiam a tese de que a atividade física é uma intervenção útil, que pode ser utilizada em conjunto com terapias convencionais durante o tratamento da fadiga relacionada ao câncer. Objetivo: O objetivo deste estudo é avaliar o impacto de dois programas de exercício físico sobre os níveis de fadiga e desempenho físico de pacientes com câncer. Método: Relato deuma série consecutiva de 44 doentes adultos com doença neoplásica (sólido ou hematológicas), e diagnósticomédico de fadiga, submetidos a dois diferentes programas de exercício físico. Todos os doentes foramavaliados quanto a desempenho físico com o uso do teste de caminhada de 6 minutos e avaliados quantoaos níveis de fadiga com o teste de Piper, antes e depois de 4 meses de atividade física supervisionada(exercícios aeróbicos isolados e treino de resistência combinado ao exercícios aeróbicos). Resultados: Após16 semanas, os doentes que participaram do programa de exercícios aeróbicos ou que participaram doprotocolo de exercício aeróbico combinado com anaeróbio, relataram níveis significativamente mais elevadosdo desempenho físico (6 minutos teste de caminhada, p = 0,0009 e p = 0,001, respectivamente) eníveis de fadiga significativamente menor (PFS- R, p = 0,003 e p = 0,002, respectivamente) do que no iníciodo programa de exercícios. Conclusão: Estes resultados demonstram que tanto um protocolo de exercícioaeróbico quanto de exercício aeróbico combinado com exercício anaeróbio apresentam melhora significativado desempenho físico e dos níveis de fadiga de doentes oncológicos. Os dados deste estudo corroborama literatura mostrando que a atividade física é uma estratégia eficaz para o tratamento da fadiga. Os resultadosdeste estudo confirmam que o exercício físico pode ser útil na reabilitação de sobreviventes de câncer,especialmente para pacientes com fadiga oncológica.

Cancer-related fatigue is a common symptom in patients with cancer, which is experienced by 70% to 100% of these patients and brings some impairment of physical and mental performance, hinders their working or carrying out regular daily activities, and hence results in a substantial reduction of the quality of life. Physical exercise has consistently been identified as a central element of rehabilitation for many chronic diseases like cancer, and increasing evidence supports the contention that physical activity is a valuable intervention that can be utilized in conjunction with conventional therapies during CRF treatment. Objective: The aim of this study was to assess the impact of a program of physical exercise on fatigue levels and physical performance of cancer patients. Method: A consecutive series of 44 adult patients with neoplastic disease (solid or hematological), with a medical diagnosis of fatigue, who were enrolled in an oncological treatment, with the ability to walk and willing to enter a rehabilitation program of exercise for at least 4 consecutive months. The exercise program was performed two times per week, each session lasting one hour and consisting of aerobic, resistance, and flexibility exercises. The protocol was divided into aerobic exercise and resistance training combined with aerobic exercise. The patients were evaluated with two assessments: one prior to their beginning the exercise program and other at the end of the four-month program. In both assessments the patients completed the Revised Piper Fatigue Scale and the six-minute walk test. The primary outcome of change over baseline and after 16 weeks in PFS-R score and six-minute walk test were compared using a two sample two-sided t-test for both groups. Alpha level was set at P<0.05. Results: After 16 weeks, the patients who participated in the aerobic or the combined exercise program reported significantly higher levels of physical functioning (6-minute walking test, p = 0.0009 and p = 0.001, respectively) and significantly lower fatigue (PFS-R, p = 0.003 and p = 0.002, respectively) than at the beginning the exercise program. Conclusion: The results of patients who underwent aerobic or aerobic + anaerobic exercise showed statistically significant improvement of physical performance and of fatigue. Data from this study corroborates with the literature showing that exercise programs with aerobic or resistance exercises are an effective strategy for the treatment of fatigue. The results of this study confirm that physical exercise could be useful in rehabilitation of cancer survivors, especially for fatigued patients.

Stress amplifies lung tissue mechanics, inflammation and oxidative stress induced by chronic inflammation.

BACKGROUND: Mechanisms linking behavioral stress and inflammation are poorly understood, mainly in distal lung tissue. OBJECTIVE: We have investigated whether the forced swim stress (FS) could modulate lung tissue mechanics, iNOS, cytokines, oxidative stress activation, eosinophilic recruitment, and remodeling in guinea pigs (GP) with chronic pulmonary inflammation. METHODS: The GP were exposed to ovalbumin or saline aerosols (2×/wk/4wks, OVA, and SAL). Twenty-four hours after the 4th inhalation, the GP were submitted to the FS protocol (5×/wk/2wks, SAL-S, and OVA-S). Seventy-two hours after the 7th inhalation, lung strips were cut and tissue resistance (Rt) and elastance (Et) were obtained (at baseline and after OVA and Ach challenge). Strips were submitted to histopathological evaluation. RESULTS: The adrenals' weight, the serum cortisol, and the catecholamines were measured. There was an increase in IL-2, IL-5, IL-13, IFN-γ, iNOS, 8-iso-PGF2α, and in %Rt and %Et after Ach challenge in the SAL-S group compared to the SAL one. The OVA-S group has had an increase in %Rt and %Et after the OVA challenge, in %Et after the Ach and in IL-4, 8-iso-PGF2α, and actin compared to the OVA. Adrenal weight and cortisol serum were increased in stressed animals compared to nonstressed ones, and the catecholamines were unaltered. CONCLUSION & CLINICAL RELEVANCE: Repeated stress has increased distal lung constriction, which was associated with an increase of actin, IL-4, and 8-iso-PGF2α levels. Stress has also induced an activation of iNOS, cytokines, and oxidative stress pathways.

Inducible nitric oxide synthase inhibition attenuates physical stress-induced lung hyper-responsiveness and oxidative stress in animals with lung inflammation.

Mechanisms involved in stress-induced asthmatic alterations have been poorly characterised. We assessed whether inducible nitric oxide synthase (iNOS) inhibition modulates the stress-amplified lung parenchyma responsiveness, oxidative stress and extracellular matrix remodelling that was previously increased by chronic lung inflammation. Guinea pigs were subjected to 7 exposures to ovalbumin (1-5 mg/ml) or saline (OVA and SAL groups) over 4 weeks. To induce behavioural stress, animals were subjected to a forced swimming protocol (5 times/week, over 2 weeks; SAL-Stress and OVA-Stress groups) 24 h after the 4th inhalation. 1400W (iNOS-specific inhibitor) was administered intraperitoneally in the last 4 days of the protocol (SAL-1400W, OVA-1400W, SAL-Stress+1400W and OVA-Stress+1400W groups). Seventy-two hours after the last inhalation, animals were anaesthetised and exsanguinated, and adrenal glands were removed. Lung tissue resistance and elastance were evaluated by oscillatory mechanics and submitted for histopathological evaluation. Stressed animals had higher adrenal weights compared to non-stressed groups, which were reduced by 1400W treatment. Behavioural stress in sensitised animals amplified the resistance and elastance responses after antigen challenge, numbers of eosinophils and iNOS+ cells, actin content and 8-iso-PGF2α density in the distal lung compared to the OVA group. 1400W treatment in ovalbumin-exposed and stressed animals reduced lung mechanics, iNOS+ cell numbers and 8-iso-PGF2α density compared to sensitised and stressed animals that received vehicle treatment. We concluded that stress amplifies the distal lung constriction, eosinophilic inflammation, iNOS expression, actin content and oxidative stress previously induced by chronic lung inflammation. iNOS-derived NO contributes to stress-augmented lung tissue functional alterations in this animal model and is at least partially due to activation of the oxidative stress pathway.

Effects of repeated stress on distal airway inflammation, remodeling and mechanics in an animal model of chronic airway inflammation.

BACKGROUND/AIMS: Epidemiological studies suggest that stress has an impact on asthmatic exacerbations. We evaluated if repeated stress, induced by forced swimming, modulates lung mechanics, distal airway inflammation and extracellular matrix remodeling in guinea pigs with chronic allergic inflammation. METHODS: Guinea pigs were submitted to 7 ovalbumin or saline aerosols (1-5 mg/ml during 4 weeks; OVA and SAL groups). Twenty-four hours after the 4th inhalation, guinea pigs were submitted to the stress protocol 5 times a week during 2 weeks (SAL-S and OVA-S groups). Seventy-two hours after the 7th inhalation, guinea pigs were anesthetized and mechanically ventilated. Resistance and elastance of the respiratory system were obtained at baseline and after ovalbumin challenge. Lungs were removed, and inflammatory and extracellular matrix remodeling of distal airways was assessed by morphometry. Adrenals were removed and weighed. RESULTS: The relative adrenal weight was greater in stressed guinea pigs compared to non-stressed animals (p < 0.001). Repeated stress increased the percent elastance of the respiratory system after antigen challenge and eosinophils and lymphocytes in the OVA-S compared to the OVA group (p < 0.001, p = 0.003 and p < 0.001). Neither collagen nor elastic fiber contents were modified by stress in sensitized animals. CONCLUSIONS: In this animal model, repeated stress amplified bronchoconstriction and inflammatory response in distal airways without interfering with extracellular matrix remodeling.