Effectiveness of a serious game for medical education on insulin therapy: a pilot study.

OBJECTIVE: We report the preliminary assessment of InsuOnline©, a serious game designed for medical education on insulin therapy. MATERIALS AND METHODS: We conducted a pilot study with 41 undergraduate medical students and Internal Medicine residents to assess the educational effectiveness of InsuOnline©, as compared to a traditional educational activity (lecture, cases discussion). Knowledge, skills and beliefs on insulin therapy were evaluated by a questionnaire applied before, immediately after, and 3 months after both interventions. RESULTS: Mean knowledge/skills score was improved from 68% to 89% in traditional education group (n = 23; p < 0.001), and from 61% to 90% in game group (n = 18; p < 0.001). After 3 months, mean score decreased (to 80% in traditional education group, and to 78% in game group; p < 0.001 for both) but remained significantly higher than at baseline in both groups (p < 0.001 for both). Although mean score was lower in game group than in traditional education group at baseline (p = 0.04), no difference remained between groups either immediately or 3 months post-intervention. Score increment was better with the game (29%) than with traditional education (21%; p = 0.04). Beliefs improved in the game group only. CONCLUSIONS: InsuOnline© is at least as effective as a traditional educational activity for medical education on insulin therapy, and it can a good option for large-scale continuing medical education on diabetes.

[Urinary iodine in patients with auto-immune thyroid disorders in Santo André, SP, is comparable to normal controls and has been steady for the last 10 years]. / A iodúria de pacientes portadores de tireopatias autoimunes em Santo André, SP, é comparável à dos indivíduos normais e estável nos últimos dez anos.

OBJECTIVE: Evaluate whether the increase of iodine in the diet would be the triggering factor for auto-immune thyropathies in the city of Santo André, SP. METHODS: Urinary iodine was determined in samples isolated from 58 patients, divided in 4 Groups, and in 13 normal individuals (controls). RESULTS: Urinary Iodine: Group 1--hyperthyroidism = 203.5+/-152.71 microg/ L(mean+/-sd); Group 2--hypothyroidism = 258.31+/-148,2 microg/L; Group 3--chronic auto-immune thyroiditis = 244.29+/-191.6 microg/L; Group 4--(Amiodarone) = 1157.5+/-261.8 microg/L; Group 5--Controls = 262.31+/-146.2 microg/L. On comparing the means of urinary iodine among the groups, the means for groups 1, 2, 3, and 5 did not present significant differences (p>0.05), and all differed from group 4 (p<0.05). Urinary iodine obtained in groups 1, 2, 3 and 5, obtained in 2002-03, is not different from the values determined in students in 1994 in Santo André. CONCLUSION: This study shows evidence that iodine should not be considered as the responsible agent for auto-immune thyropathies in Santo André, and other environmental factors should be investigated.

A iodúria de pacientes portadores de tireopatias autoimunes em Santo André, SP, é comparável à dos indivíduos normais e estável nos últimos dez anos / Urinary iodine in patients with auto-immune thyroid disorders in Santo André, SP, is comparable to normal controls and has been steady for the last 10 years

OBJETIVO: Avaliar se o aumento de iodo na dieta seria o fator desencadeante de tireopatias autoimunes na cidade de Santo André, SP. MÉTODOS: Determinou-se a iodúria em amostra isolada de 58 pacientes, divididos em quatro grupos e de 13 indivíduos normais (controles). RESULTADOS: Iodúria: grupo 1 - hipertireoidismo = 203,5 ± 152,71 µg/L (média ± DP); grupo 2 hipotireoidismo = 258,31 ± 148,2 µg/L; grupo 3 - tireodite crônica autoimune = 244,29 ± 191,6 µg/L; grupo 4 - amiodarona = 1.157,5 ± 261,8 µg/L; grupo 5 - controles = 262,31 ± 146,2 µg/L. Comparadas as médias da iodúria entre os cinco grupos, dos grupos 1, 2, 3 e 5 não apresentaram diferenças significantes (p > 0,05) e todos diferiram do grupo 4 (p < 0,05). A iodúria dos grupos 1, 2, 3 e 5, obtida em 2002 e 2003, não diferiram dos valores determinados em 1994 em escolares em Santo André. CONCLUSÃO: Este estudo evidencia que o iodo não deve ser considerado o agente responsável pelas tireopatias autoimunes em Santo André, e outros fatores ambientais devem ser investigados.

OBJECTIVE: Evaluate whether the increase of iodine in the diet would be the triggering factor for auto-immune thyropathies in the city of Santo André, SP. METHODS: Urinary iodine was determined in samples isolated from 58 patients, divided in 4 Groups, and in 13 normal individuals (controls). RESULTS: Urinary Iodine: Group 1 - hyperthyroidism = 203.5±152.71 µg/ L(mean±sd); Group 2 - hypothyroidism = 258.31±148,2 µg/L; Group 3 - chronic auto-immune thyroiditis = 244.29±191.6 µg/L; group 4 (Amiodarone) = 1157.5±261.8 µg/L; Group 5 - Controls = 262.31±146.2 µg/L. On comparing the means of urinary iodine among the groups, the means for groups 1, 2, 3, and 5 did not present significant differences (p>0.05), and all differed from group 4 (p<0.05). Urinary iodine obtained in groups 1, 2, 3 and 5, obtained in 2002-03, is not different from the values determined in students in 1994 in Santo André. CONCLUSION: This study shows evidence that iodine should not be considered as the responsible agent for auto-immune thyropathies in Santo André, and other environmental factors should be investigated.

Desenvolvimento de um método para a determinação da iodúria e sua aplicação na excreção urinária de iodo em escolares brasileiros / Development of a semi-automated method for measuring urinary iodine and its application in epidemiological studies in brazilian schoolchildren

Desenvolvemos método semi-automatizado em placa para a determinação de iodo urinário; utilizamos, primeiramente, a digestão das amostras de urina com persulfato de amônio e, a seguir, estimamos a quantidade de iodo pela redução do sulfato cérico amoniacal. O método foi validado no inquérito nacional de monitoração da deficiência de iodo, realizado em 1994, que empregou um sistema de amostragem mista da população brasileira e analisou a iodúria em 16.803 amostras de urina de escolares obtidas por coleta casual. Em 401 municípios estudados encontramos 4 com deficiência de iodo de grau moderado (Almas, Arraias e Paraná, em Tocantins, e Cocos, na Bahia) e 116 de grau leve. Desta forma, este estudo mostrou a presença de regiões com deficiência de iodo em 1994, a despeito do programa de iodação do sal. Dados recentes de outros autores, com número menor de municípios, indicam excesso de ingestão de iodo. Assim, num país de dimensões continentais e heterogêneo como o Brasil, é necessária a realização de avaliações periódicas de amplitude nacional para a verificação da ingestão de iodo da população. O método apresentado neste estudo apresenta as características de simplicidade e eficiência necessários para este tipo de estudo populacional.

In this study we developed a semi-automated method for the measurement of urinary iodine using firstly ammonium persulfate for digestion of urine followed by estimation of iodine content in the Sandell-Kolthoff reaction, in which iodine acts as a catalyst for the reduction of cerium. This method was validated in the 3rd Brazilian National Survey of iodine deficiency in 1994. We studied 16,803 casual urine samples from schoolchildren of 401 cities and found 4 moderately-deficient towns (Almas, Arraias, and Parana, in the State of Tocantins, and Cocos, in the State of Bahia), and 116 mildly-deficient. This work suggests that despite the salt iodization program, there was some iodine-deficient areas in Brazil in 1994. Recent surveys, involving less cities, are indicating an excess of iodine ingestion. Therefore, in a country of continental dimensions and very heterogeneous in terms of public health, periodical evaluations are necessary to monitor the real situation of iodine nutrition in Brazil. The method developed in this paper is suitable for these surveys.

[Development of a semi-automated method for measuring urinary iodine and its application in epidemiological studies in Brazilian schoolchildren]. / Desenvolvimento de um método para a determinação da iodúria e sua aplicação na excreção urinária de iodo em escolares brasileiros.

In this study we developed a semi-automated method for the measurement of urinary iodine using firstly ammonium persulfate for digestion of urine followed by estimation of iodine content in the Sandell-Kolthoff reaction, in which iodine acts as a catalyst for the reduction of cerium. This method was validated in the 3rd Brazilian National Survey of iodine deficiency in 1994. We studied 16,803 casual urine samples from schoolchildren of 401 cities and found 4 moderately-deficient towns (Almas, Arraias, and Parana, in the State of Tocantins, and Cocos, in the State of Bahia), and 116 mildly-deficient. This work suggests that despite the salt iodization program, there was some iodine-deficient areas in Brazil in 1994. Recent surveys, involving less cities, are indicating an excess of iodine ingestion. Therefore, in a country of continental dimensions and very heterogeneous in terms of public health, periodical evaluations are necessary to monitor the real situation of iodine nutrition in Brazil. The method developed in this paper is suitable for these surveys.

Atividade colinesterásica em tireóide de ratos: resposta a uma sobrecarga de iodo / Cholinesterase activity in thyroid of rats: response the a iodine overload

A utilização do iodo antes de cirurgias de tireóide visa a redução do fluxo sanguíneo para a glândula e melhora da hemostasia. Para tentar elucidar o mecanismo pelo qual a vasoconstricção se instala, foi determinada a atividade colinesterásica em tireóides de ratos Wistar machos (240-250g de peso corporal), submetidos a uma sobrecarga oral de iodo pela oferta de solução aquosa de iodato de potássio (KIO 3 3µg/ml) como água de beber, por 3 e 7 dias; o grupo controle recebeu água durante o mesmo período. Ao final do tratamento os animais foram sacrificados e suas tireóides retiradas, limpas e pesadas; o rim direito e o lobo direito do fígado foram usados como controles da atividade colinesterásica. Foram preparados homogeneizados em tampão fosfato (pH=8,0), contendo 0,32M de sacarose, na concentração de 40mg de tecido/ml. Os ratos que receberam KIO 3 por 7 dias tiveram diminuição no peso da tireóide quando comparados aos controles (p<0,05), o mesmo não acontecendo aos 3 dias de tratamento. Aos 3 dias de tratamento, a atividade colinesterásica tireóidea foi de 5,38ñ0,36 nmol/min.mg para o grupo controle (n=12) e de 5,43ñ0,98 nmol/min.mg para o grupo tratado (n=11) (NS); valores bastante similares foram também encontrados com o tratamento de 7 dias (controles: 5,42ñ0,27 nmol/min.mg [n=8] e tratados: 5,63ñ0,88 nmol/min.mg [n=8]; NS). Nossos resultados sugerem que, a despeito da vasoconstricção, não há alteração da atividade colinesterásica na tireóide em resposta a sobrecarga oral de iodo.