Relacionamentos amorosos na contemporaneidade: um estudo exploratório sobre expectativas e experiências das mulheres / Loving relationships: an exploratory research on the expectations and life experiences of women / Relaciones amorosas contemporáneas: un estudio exploratorio sobre las expectativas y experiencias de las mujeres

O presente artigo apresenta os resultados parciais de pesquisa realizada com 2778 mulheres, intitulada "Relacionamentos amorosos na contempo-raneidade: quais as expectativas das mulheres?" (Millan et al., 2019), que visou à compreensão das relações afetivo-sexuais na contemporaneidade a partir da visão das mulheres e o conhecimento da dinâmica das relações com seus pares, com vistas ao manejo de conflitos nos relacionamentos afetivos e familiares, em intervenções clínicas e sociais. Teve-se como objetivo destacar aspectos relativos às diferenças entre expectativas e experiências vividas nos relacionamentos, no que diz respeito aos papéis de gênero (desempenho das tarefas domésticas e cuidados com filhos), à vida profissional, à independência financeira, aos sonhos e projetos de vida. A metodologia utilizada foi de carac-terística quantitativa e qualitativa, com as respostas ao questionário tratadas como variáveis qualitativas ordinais e analisadas pelos testes estatísticos não paramétricos de Kruskal-Wallis ou de Mann-Whitney (1952), de acordo com o agrupamento das participantes, quanto à faixa etária, escolaridade e estado civil. As variáveis categóricas foram analisadas pelo Teste de Qui-quadrado ou pelo Teste Exato de Fisher, conforme a indicação. Na análise qualitativa, adotaram-se os referenciais psicanalítico e sistêmico. Os resultados obtidos mostram que as expectativas das mulheres nos relacionamentos amorosos são moduladas pela experiência vivida e passíveis de ajustes e reajustes durante o ciclo vital pessoal e familiar. As variáveis independentes (escolaridade, estado civil, faixa etária) influenciaram significativamente e de maneiras distintas as respostas analisadas neste artigo. Conclui-se que os relacionamentos amorosos expressam elementos próprios da contemporaneidade, na qual convivem tendências variadas de valores, condutas e pontos de vista dissonantes, em constante transformação.

This article reports partial results of the research "Loving relationships in contemporary times: what are women's expectations?" (Millan et al., 2019) carried out with 2,778 women, that aimed to comprehend affective-sexual rela-tionships in the contemporary era, from women's point of view and knowledge of the dynamics in their relationships with their peers, in order to develop clinical tools to manage conflicts in affective and familiar relationships, via clinical and social interventions. Its objective is to highlight aspects concerning differences between expectations and experiences in relationships, regarding gender roles (in the performance of household tasks and childcare), profes-sional life, financial independence, life dreams and projects. Quantitative and qualitative data were obtained, while answers to the questionnaire were labeled as qualitative ordinal variables and analyzed through Kruskal-Wallis or Mann-Whitney (1952) nonparametric statistical tests, according to the grouping of participants, by age, education and marital status. Categorical variables were analyzed through a Chi-squared Test or Fisher's exact test, as appropriate. In the qualitative analysis, psychoanalytic and systemic refe-rences were adopted. The obtained results show that women's expectations towards loving relationships are influenced by life experiences and prone to change throughout personal and familiar life cycles. The independent varia-bles (education, age, marital status) have significantly influenced the results in different ways. It is concluded that loving relationships express elements characteristic of contemporaneity, which presents several tendencies, diverse in values, conducts and dissonant points of view, in constant transformation.

Este artículo presenta los resultados parciales de una investigación realizada con una muestra de 2.778 mujeres, denominada "Relaciones amorosas en la actualidad: ¿cuáles son las expectativas de las mujeres?" (Millan et al., 2019), que tuvo como objetivo comprender las relaciones afectivo-sexuales en la contemporaneidad desde la perspectiva de las mujeres y el conocimiento de la dinámica de las relaciones con sus pares, con miras a gestionar los conflictos en las relaciones afectivas y familiares en intervenciones clínicas y sociales. El objetivo fue resaltar aspectos relacionados con las diferencias entre expec-tativas y experiencias vividas en las relaciones, en cuanto a roles de género (desempeño de las tareas del hogar y cuidado de los niños), vida profesional, independencia económica, sueños y proyectos de vida. La metodología utilizada fue cuantitativa y cualitativa, con las respuestas a las entrevistas tratadas como variables cualitativas ordinales y analizadas mediante las pruebas estadísticas no paramétricas de Kruskal-Wallis o Mann-Whitney (1952), agrupando las participantes en función del grupo etario, nivel de educación y estado civil. Las variables categóricas se analizaron mediante la prueba de Chi-cuadrado o la prueba exacta de Fisher, según se indica en cada caso. En el análisis cualitativo se adoptaron referencias psicoanalíticas y sistémicas. Los resultados obtenidos muestran que las expectativas de las mujeres en las relaciones amorosas están moduladas por la experiencia vivida y están sujetas a ajustes y reajustes durante el ciclo de vida personal y familiar. Las variables independientes (nivel de educación, estado civil, grupo etario) influyeron significativamente de diferentes formas en las respuestas analizadas en este artículo. Se concluye que las relaciones amorosas expresan elementos de contemporaneidad en los que conviven diferentes tendencias de valores, comportamientos y puntos de vista disonantes en constante transformación.

Modelling the test, trace and quarantine strategy to control the COVID-19 epidemic in the state of São Paulo, Brazil.

Testing for detecting the infection by SARS-CoV-2 is the bridge between the lockdown and the opening of society. In this paper we modelled and simulated a test-trace-and-quarantine strategy to control the COVID-19 outbreak in the State of São Paulo, Brasil. The State of São Paulo failed to adopt an effective social distancing strategy, reaching at most 59% in late March and started to relax the measures in late June, dropping to 41% in 08 August. Therefore, São Paulo relies heavily on a massive testing strategy in the attempt to control the epidemic. Two alternative strategies combined with economic evaluations were simulated. One strategy included indiscriminately testing the entire population of the State, reaching more than 40 million people at a maximum cost of 2.25 billion USD, that would reduce the total number of cases by the end of 2020 by 90%. The second strategy investigated testing only symptomatic cases and their immediate contacts - this strategy reached a maximum cost of 150 million USD but also reduced the number of cases by 90%. The conclusion is that if the State of São Paulo had decided to adopt the simulated strategy on April the 1st, it would have been possible to reduce the total number of cases by 90% at a cost of 2.25 billion US dollars for the indiscriminate strategy but at a much smaller cost of 125 million US dollars for the selective testing of symptomatic cases and their contacts.

Modelling the test, trace and quarantine strategy to control the COVID-19 epidemic in the state of São Paulo, Brazil

Testing for detecting the infection by SARS-CoV-2 is the bridge between the lockdown and the opening of society. In this paper we modelled and simulated a test-trace-and-quarantine strategy to control the COVID-19 outbreak in the State of São Paulo, Brasil. The State of São Paulo failed to adopt an effective social distancing strategy, reaching at most 59% in late March and started to relax the measures in late June, dropping to 41% in 08 August. Therefore, São Paulo relies heavily on a massive testing strategy in the attempt to control the epidemic. Two alternative strategies combined with economic evaluations were simulated. One strategy included indiscriminately testing the entire population of the State, reaching more than 40 million people at a maximum cost of 2.25 billion USD, that would reduce the total number of cases by the end of 2020 by 90%. The second strategy investigated testing only symptomatic cases and their immediate contacts – this strategy reached a maximum cost of 150 million USD but also reduced the number of cases by 90%. The conclusion is that if the State of São Paulo had decided to adopt the simulated strategy on April the 1st, it would have been possible to reduce the total number of cases by 90% at a cost of 2.25 billion US dollars for the indiscriminate strategy but at a much smaller cost of 125 million US dollars for the selective testing of symptomatic cases and their contacts.

Cost-effectiveness analysis of universal adult immunization with tetanus-diphtheria-acellular pertussis vaccine (Tdap) versus current practice in Brazil.

BACKGROUND: A pertussis outbreak occurred in Brazil from 2011 to 2014, despite high coverage of whole-cell pertussis containing vaccines in early childhood. Infants were the most affected. This study aimed to evaluate the cost-effectiveness of introducing universal adult vaccination with Tdap into the National Immunization Program in Brazil. METHODS: Economic evaluation using a dynamic model to compare two strategies: (1) universal vaccination with single dose of Tdap at 20 years of age and (2) current practice (only pregnant women pertussis vaccination). The health system perspective was adopted. Temporal horizon was 10 years. Discount rate of 5% was applied to costs and benefits. Vaccine effectiveness (VE) was obtained from a population-based observational study. Epidemiological, resource utilization and cost estimates were obtained from the Brazilian Health Information Systems. The primary outcome was cost per life year saved (LYS), based on life expectancy at birth in Brazil in 2015. Univariate and multivariate sensitivity analysis were performed. RESULTS: Adult vaccination with VE of 82.6% and coverage of 40%, at price of US$7.01 per dose, and assuming herd protection would avoid 167 infant deaths by pertussis, saving 12,325 years of life and costing a total of US$105495891.61, from the health system perspective. The universal immunization would result in ICER of US$8459.13. The results were highly sensitive to disease incidence. CONCLUSIONS: The results suggest that universal adult vaccination with Tdap would not be a cost-effective intervention for preventing pertussis cases and deaths in infants in Brazil.

Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever cases.

BACKGROUND: Despite a highly efficacious vaccine, yellow fever (YF) is still a major threat in developing countries and a cause of outbreaks. In 2018, the Brazilian state of São Paulo witnessed a new YF outbreak in areas where the virus has not been detected before. OBJECTIVE: The aim is to describe the clinical and laboratorial characteristics of severe cases of YF, evaluate viral to determine markers associated with fatal outcome. METHODS: Acute severe YF cases (n = 62) were admitted to the Intensive Care Unit of a reference hospital and submitted to routine laboratorial evaluation on admission. YFV-RNA was detected in serum and urine by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and then sequenced. Patients were classified in two groups: survival or death. FINDINGS: In the univariate analysis the following variables were associated with outcome: alanin aminotransferase (ALT), aspartat aminotransferase (AST), AST/ALT ratio, total bilirubin (TB), chronic kidney disease epidemiology collaboration (CKD-EPI), ammonia, lipase, factor V, international normalised ratio (INR), lactate and bicarbonate. Logistic regression model showed two independent variables associated with death: lipase [odds ratio (OR) 1.018, 95% confidence interval (CI) 1.007 to 1.030, p = 0.002], and factor V (OR -0.955, 95% CI 0.929 to 0.982, p = 0.001). The estimated lipase and factor V cut-off values that maximised sensitivity and specificity for death prediction were 147.5 U/L [area under the curve (AUC) = 0.879], and 56.5% (AUC = 0.913). MAIN CONCLUSIONS: YF acute severe cases show a generalised involvement of different organs (liver, spleen, heart, kidneys, intestines and pancreas), and different parameters were related to outcome. Factor V and lipase are independent variables associated with death, reinforcing the importance of hemorrhagic events due to fulminant liver failure and pointing to pancreatitis as a relevant event in the outcome of the disease.

Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever cases

BACKGROUND Despite a highly efficacious vaccine, yellow fever (YF) is still a major threat in developing countries and a cause of outbreaks. In 2018, the Brazilian state of São Paulo witnessed a new YF outbreak in areas where the virus has not been detected before. OBJECTIVE The aim is to describe the clinical and laboratorial characteristics of severe cases of YF, evaluate viral to determine markers associated with fatal outcome. METHODS Acute severe YF cases (n = 62) were admitted to the Intensive Care Unit of a reference hospital and submitted to routine laboratorial evaluation on admission. YFV-RNA was detected in serum and urine by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and then sequenced. Patients were classified in two groups: survival or death. FINDINGS In the univariate analysis the following variables were associated with outcome: alanin aminotransferase (ALT), aspartat aminotransferase (AST), AST/ALT ratio, total bilirubin (TB), chronic kidney disease epidemiology collaboration (CKD-EPI), ammonia, lipase, factor V, international normalised ratio (INR), lactate and bicarbonate. Logistic regression model showed two independent variables associated with death: lipase [odds ratio (OR) 1.018, 95% confidence interval (CI) 1.007 to 1.030, p = 0.002], and factor V (OR -0.955, 95% CI 0.929 to 0.982, p = 0.001). The estimated lipase and factor V cut-off values that maximised sensitivity and specificity for death prediction were 147.5 U/L [area under the curve (AUC) = 0.879], and 56.5% (AUC = 0.913). MAIN CONCLUSIONS YF acute severe cases show a generalised involvement of different organs (liver, spleen, heart, kidneys, intestines and pancreas), and different parameters were related to outcome. Factor V and lipase are independent variables associated with death, reinforcing the importance of hemorrhagic events due to fulminant liver failure and pointing to pancreatitis as a relevant event in the outcome of the disease.

Correlation between the expression of vegf and survival in osteosarcoma.

OBJECTIVE: To present a series of 50 consecutive patients with non-metastatic extremity osteosarcoma, and attempt to correlate expression of the vascular endothelial growth factor (VEGF) protein in biopsy tissue to their prognosis regarding overall survival, disease-free survival and local recurrence. METHODS: Fifty cases of non-metastatic osteosarcoma of the extremities treated between 1986 and 2006 at Instituto de Ortopedia e Traumatologia da Universidade de São Paulo, São Paulo, Brasil, were evaluated regarding expression of the VEGF protein. There were 19 females and 31 males. The mean age was 16 years old (range 5-28 years old) and the mean follow-up was 60.6 months (range 25-167 months). The variables studied were age, gender, anatomic location, type of surgery, surgical margins, tumor size, post chemotherapy necrosis, local recurrence, pulmonary metastasis and death. RESULTS: Thirty-six patients showed VEGF expression on 30% or less cells (low), and the remaining 14 cases had VEGF expression above 30% (high). Among the 36 patients with low VEGF expression, nine developed pulmonary metastasis and four died (11.1%). Among the 14 patients with high VEGF expression, six developed pulmonary metastasis and three died (21.4%). CONCLUSION: There was no statistically significant correlation between the expression of VEGF and any of the variables studied. Level of Evidence IV, Therapeutic Study.

Correlation between the expression of VEGF and survival in osteosarcoma

Apresentar uma série de 50 casos consecutivos de pacientescom osteossarcoma de extremidade não metastático, e tentarcorrelacionar a expressão da proteína VEGF na biópsia com o prognóstico– sobrevida global, sobrevida livre da doença e recorrêncialocal. Métodos: Cinquenta casos de osteossarcoma de extremidadenão metastático tratados entre 1986 e 2006 no Instituto de Ortopediae Traumatologia da Universidade de São Paulo São Paulo, Brasil,foram avaliados quanto à expressão de VEGF. Havia 19 pacientesfemininos e 31 masculinos. A média de idade foi 16 anos (intervalo,5-28 anos) e o seguimento médio foi de 60,6 meses (intervalo, 25-167 meses). As variáveis estudadas foram idade, gênero, localizaçãoanatômica, tipo de cirurgia, margens cirúrgicas, tamanho do tumor,necrose pós-quimioterapia, recorrência local, metástases pulmonarese morte. Resultados: Trinta e seis pacientes mostraram expressãode VEGF igual ou menor a 30% das células (baixo), e os 14 restantesmostraram expressão de VEGF acima de 30% (alto). Entre os 36pacientes com baixa expressão, nove desenvolveram metástasespulmonares e quatro morreram (11,1%). Entre os 14 pacientes comalta expressão de VEGF, seis desenvolveram metástases pulmonarese três morreram (21,4%). Conclusão: Não houve correlaçãosignificativa entre a expressão de VEGF com nenhuma das variáveisestudadas. Nível de Evidência IV, Estudo Terapêutico...

To present a series of 50 consecutive patients withnon-metastatic extremity osteosarcoma, and attempt to correlateexpression of the VEGF protein in biopsy tissue to their prognosisregarding overall survival, disease-free survival and local recurrence.Methods: Fifty cases of non-metastatic osteosarcoma ofthe extremities treated between 1986 and 2006 at Instituto deOrtopedia e Traumatologia da Universidade de São Paulo, SãoPaulo, Brasil, were evaluated regarding expression of the VEGFprotein. There were 19 females and 31 males. The mean age was16 years old (range 5-28 years old) and the mean follow-up was60.6 months (range 25-167 months). The variables studied wereage, gender, anatomic location, type of surgery, surgical margins,tumor size, post chemotherapy necrosis, local recurrence, pulmonarymetastasis and death. Results: Thirty-six patients showedVEGF expression on 30% or less cells (low), and the remaining14 cases had VEGF expression above 30% (high). Among the 36patients with low VEGF expression, nine developed pulmonarymetastasis and four died (11.1%). Among the 14 patients withhigh VEGF expression, six developed pulmonary metastasis andthree died (21.4%). Conclusion: There was no statistically significantcorrelation between the expression of VEGF and any of thevariables studied. Level of Evidence IV, Therapeutic Study...

Are CYP1A1, CYP17 and CYP1B1 mutation genes involved on girls with precocious puberty? A pilot study.

OBJECTIVES: To investigate three genes associated with puberty timing in girls with central precocious puberty by evaluating the association between polymorphism in the gene sequence codifying the enzymes participating in steroidogenesis, CYP1A1, CYP17, and CYP1B1 and central precocious puberty. STUDY DESIGN: A total of 177 patients was included and divided into two groups: Case group with 73 girls diagnosed with central precocious puberty; Control group with 104 girls with puberty onset after 8 years of age who were followed at the Sector of Gynecology of Childhood and Adolescence, Division of Gynecology Clinic, HC-FMUSP. Polymorphism presence was assessed in the genes involved in estrogen metabolism (CYP1A1, CYP17, and CYP1B1) by the restriction fragment length polymorphism (RFLP) technique using DNA from peripheral blood. RESULTS: No significant difference in the distribution of the CYP1A1 Mspl (p=0.86) and CYP17 (p=0.12) genotypes was detected between the two study groups. As for CYP1B1 Eco571, the mutated C/C genotype was found to be more frequent in the control group than in the case group (p=0.03). CONCLUSION: Our data suggest the CYP1B1 Eco571 gene variant is associated with puberty timing.

Karyotypic and fluorescent in-situ hybridization study of the centromere of chromosome 7 in secondary myeloid neoplasms

BACKGROUND: Secondary myeloid neoplasms comprise a group of secondary diseases following exposure to myelotoxic agents or due to congenital diseases. The improvement of anticancer agents and immunosuppressive drugs seem to be associated with an increased incidence of secondary myeloid neoplasms. Karyotyping of bone marrow is essential for diagnosis and prognosis. Previous use of alkylating agents and radiation are associated with clonal abnormalities such as recurrent unbalanced -5/5q-, -7/7q- and complex karyotypes, whereas topoisomerase-II inhibitors lead to changes such as the balanced 11q23 rearrangement, t(8;21), t(15;17) and inv(16). OBJECTIVE: To study the clinical and cytogenetic data of patients with secondary myeloid neoplasms who took antineoplastic and/or immunosuppressive drugs or progressed from aplastic anemia. METHODS: The clinical and cytogenetic characteristics of 42 patients diagnosed with secondary myeloid neoplasms in one institution were retrospectively evaluated. Of these, 25, 11 and 6 patients had had oncological diseases, aplastic anemia and other diseases, respectively. Conventional cytogenetic and FISH analyses were performed for monosomy 7. RESULTS: The cytogenetic study was conclusive in 32 cases with 84.4 percent of clonal abnormalities. Monosomy 7 and complex karyotypes were present in 44.4 percent and 37 percent, respectively. A high prevalence of unbalanced abnormalities (96.3 percent) was observed. Monosomy 7 was more prevalent in patients with myelodysplastic syndromes/myeloid neoplasms after aplastic anemia (66.6 percent). The median survival after diagnosis of myeloid neoplasms was only 5.7 months. Normal cytogenetics was associated to better survival (p-value = 0.03). There was a slightly worse trend of survival for patients with complex karyotypes (p-value = 0.057). Abnormal karyotype was an independent risk factor for poor survival (p-value = 0.012). CONCLUSION: This study enhances the importance ...

Hepatitis B (HBV), hepatitis C (HCV) and hepatitis delta (HDV) viruses in the Colombian population--how is the epidemiological situation?

BACKGROUND: Viral hepatitis B, C and delta still remain a serious problem worldwide. In Colombia, data from 1980s described that HBV and HDV infection are important causes of hepatitis, but little is known about HCV infection. The aim of this study was to determine the currently frequency of HBV, HCV and HDV in four different Colombian regions. METHODOLOGY/PRINCIPAL FINDINGS: This study was conducted in 697 habitants from 4 Colombian departments: Amazonas, Chocó, Magdalena and San Andres Islands. Epidemiological data were obtained from an interview applied to each individual aiming to evaluate risk factors related to HBV, HCV or HDV infections. All samples were tested for HBsAg, anti-HBc, anti-HBs and anti-HCV markers. Samples that were positive to HBsAg and/or anti-HBc were tested to anti-HDV. Concerning the geographical origin of the samples, the three HBV markers showed a statistically significant difference: HBsAg (p = 0.033) and anti-HBc (p<0.001) were more frequent in Amazonas and Magdalena departments. Isolated anti-HBs (a marker of previous vaccination) frequencies were: Chocó (53.26%), Amazonas (32.88%), Magdalena (17.0%) and San Andrés (15.33%)--p<0.001. Prevalence of anti-HBc increased with age; HBsAg varied from 1.97 to 8.39% (p = 0.033). Amazonas department showed the highest frequency for anti-HCV marker (5.68%), while the lowest frequency was found in San Andrés Island (0.66%). Anti-HDV was found in 9 (5.20%) out of 173 anti-HBc and/or HBsAg positive samples, 8 of them from the Amazonas region and 1 from them Magdalena department. CONCLUSIONS/SIGNIFICANCE: In conclusion, HBV, HCV and HDV infections are detected throughout Colombia in frequency levels that would place some areas as hyperendemic for HBV, especially those found in Amazonas and Magdalena departments. Novel strategies to increase HBV immunization in the rural population and to strengthen HCV surveillance are reinforced by these results.

Karyotypic and fluorescent in situ hybridization study of the centromere of chromosome 7 in secondary myeloid neoplasms.

BACKGROUND: Secondary myeloid neoplasms comprise a group of secondary diseases following exposure to myelotoxic agents or due to congenital diseases. The improvement of anticancer agents and immunosuppressive drugs seem to be associated with an increased incidence of secondary myeloid neoplasms. Karyotyping of bone marrow is essential for diagnosis and prognosis. Previous use of alkylating agents and radiation are associated with clonal abnormalities such as recurrent unbalanced -5/5q-, -7/7q- and complex karyotypes, whereas topoisomerase-II inhibitors lead to changes such as the balanced 11q23 rearrangement, t(8;21), t(15;17) and inv(16). OBJECTIVE: To study the clinical and cytogenetic data of patients with secondary myeloid neoplasms who took antineoplastic and/or immunosuppressive drugs or progressed from aplastic anemia. METHODS: The clinical and cytogenetic characteristics of 42 patients diagnosed with secondary myeloid neoplasms in one institution were retrospectively evaluated. Of these, 25, 11 and 6 patients had had oncological diseases, aplastic anemia and other diseases, respectively. Conventional cytogenetic and FISH analyses were performed for monosomy 7. RESULTS: The cytogenetic study was conclusive in 32 cases with 84.4% of clonal abnormalities. Monosomy 7 and complex karyotypes were present in 44.4% and 37%, respectively. A high prevalence of unbalanced abnormalities (96.3%) was observed. Monosomy 7 was more prevalent in patients with myelodysplastic syndromes/myeloid neoplasms after aplastic anemia (66.6%). The median survival after diagnosis of myeloid neoplasms was only 5.7 months. Normal cytogenetics was associated to better survival (p-value = 0.03). There was a slightly worse trend of survival for patients with complex karyotypes (p-value = 0.057). Abnormal karyotype was an independent risk factor for poor survival (p-value = 0.012). CONCLUSION: This study enhances the importance of cytogenetic analysis of patients at the time of diagnosis of secondary myeloid neoplasms.

[Profile of the resident physician attended by the Group of Psychological Assistance for Students at the São Paulo University School of Medicine]. / Perfil do médico residente atendido no Grupo de Assistência Psicológica ao Aluno (GRAPAL) da Faculdade de Medicina da Universidade de São Paulo.

OBJECTIVES: To define the profile of medical residents assisted by a mental health care service, aiming to contribute to the understanding of this group's needs. METHODS: Observational study, retrospective cohort design. Data were collected from the medical records of a series of residents assisted by the group of psychological care for students of the Sao Paulo University School of Medicine , during the period 1998-2002; and from the institution's general register of residents. Proportions of residents assisted according to time, year of residency, gender , age, specialty, graduation school and distance from family home are described and differences between proportions of these variables categories are analyzed. RESULTS: The total of residents included was 2,131 with a follow-up time of 4,727 resident-years. Among them, computing first episode of care only, there were 104 residents assisted (4.9% residents assisted, or 2.2 residents assisted per 100 resident-years of follow-up). Their most frequent characteristics were: first year of residency (4.5%), age under 26 years (6.1%), female (6.9%), graduates from other schools (5.9%), and residents of cognitive specialties (6.7%). Psychiatric assistance in this sample shows an association with gender and factors related to a crisis of adaptation. The proportion of residents assisted has not increased during the period analyzed.

Perfil do médico residente atendido no Grupo de Assistência Psicológica ao Aluno (GRAPAL) da Faculdade de Medicina da Universidade de São Paulo / Profile of the resident physician attended by the Group of Psychological Assistance for Students at the São Paulo University School of Medicine

OBJETIVOS: Definir o perfil do médico residente atendido em um serviço de assistência à saúde mental a fim de contribuir para o conhecimento das necessidades deste grupo. MÉTODOS: Estudo observacional do tipo coorte retrospectivo. Os dados foram obtidos por meio de revisão de prontuários de uma série de residentes atendidos pelo Grupo de Assistência Psicológica ao Aluno (Grapal) no período de 1998 a 2002 e pelo acesso ao registro geral de matrícula de residentes. Inclui a descrição da proporção de residentes atendidos segundo ano [cronológico], ano de residência, sexo, idade, especialidade, faculdade de origem e distância do núcleo familiar; e a análise das diferenças de proporções entre as categorias das variáveis investigadas. RESULTADOS: Durante o período estudado temos o registro de 2.131 residentes matriculados, totalizando 4.727 residentes-ano de seguimento. Neste conjunto, computando-se somente o primeiro atendimento, temos 104 residentes atendidos pelo Grapal (4,9 por cento residentes atendidos, ou 2,2 atendidos para cada 100 residentes-ano de seguimento). Os dados revelam maior proporção de residentes atendidos com as seguintes características: primeiro ano de residência (4,5 por cento), idade inferior a 26 anos (6,1 por cento), sexo feminino (6,9 por cento), egresso de outras escolas médicas (5,9 por cento) e residentes de especialidades cognitivas (6,7 por cento). CONCLUSÃO: A assistência psiquiátrica mostrou-se associada ao gênero, a fatores ligados a crises adaptativas e a especialidades cognitivas. Não houve crescimento da proporção de residentes atendida pelo serviço durante o período analisado.

OBJECTIVES: To define the profile of medical residents assisted by a mental health care service, aiming to contribute to the understanding of this group's needs. Methods: Observational study, retrospective cohort design. Data were collected from the medical records of a series of residents assisted by the group of psychological care for students of the Sao Paulo University School of Medicine , during the period 1998-2002; and from the institution's general register of residents. Proportions of residents assisted according to time, year of residency, gender , age, specialty, graduation school and distance from family home are described and differences between proportions of these variables categories are analyzed. RESULTS: The total of residents included was 2,131 with a follow-up time of 4,727 resident-years. Among them, computing first episode of care only, there were 104 residents assisted (4.9 percent residents assisted, or 2.2 residents assisted per 100 resident-years of follow-up). Their most frequent characteristics were: first year of residency (4.5 percent), age under 26 years (6.1 percent), female (6.9 percent), graduates from other schools (5.9 percent), and residents of cognitive specialties (6.7 percent).Psychiatric assistance in this sample shows an association with gender and factors related to a crisis of adaptation. The proportion of residents assisted has not increased during the period analyzed.

A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia.

OBJECTIVE: To evaluate the effectiveness of acupuncture for fibromyalgia. METHODS: Fifty-eight women with fibromyalgia were allocated randomly to receive either acupuncture together with tricyclic antidepressants and exercise (n=34), or tricyclic antidepressants and exercise only (n=24). Patients rated their pain on a visual analogue scale. A blinded assessor evaluated both the mean pressure pain threshold value over all 18 fibromyalgia points and quality of life using SF-36. RESULTS: At the end of 20 sessions, patients who received acupuncture were significantly better than the control group in all measures of pain and in 5 of the SF-36 subscales. After 6 months, the acupuncture group was significantly better than the control group in numbers of tender points, mean pressure pain threshold at the 18 tender points and 3 subscales of SF-36. After one year, the acupuncture group showed significance in one subscale of the SF-36; at 2 years there were no significant differences in any outcome measures. CONCLUSION: Addition of acupuncture to usual treatments for fibromyalgia may be beneficial for pain and quality of life for 3 months after the end of treatment. Future research is needed to evaluate the specific effects of acupuncture for fibromyalgia.

Estudo longitudinal da prevalência dos vírus Juquitiba e Araraquara em roedores das regiões da Mata Atlântica e do Cerrado do Brasil / Longitudinal study of the prevalence of Juquitiba and Araraquara virus in rodents provenient of the regions of Cerrado and Atlantic Rainforest in Brazil

Com base nos estudos realizados no período de 1993 a 2003, durante a vigilância ecoepidemiológica de hantavírus em regiões de Mata Atlântica e do Cerrado do Brasil, relata-se a prevalência e os fatores relacionados à infecção pelos hantavírus Araraquara e Juquitiba nas populações de Bolomys lasiurus e Oligoryzomys nigripes, respectivamente. Foram realizadas capturas mensais de roedores em diversas localidades do País, nas quais foram detectados casos humanos de síndrome cardiopulmonar por hantavírus. Foram coletadas amostras de sangue para sorologia e detecção de anticorpos específicos para hantavírus e obteve-se de cada roedor dados referentes à espécie, peso, idade, sexo, condições reprodutivas e presença de cicatrizes. As variáveis qualitativas nominais foram organizadas em software de planilha eletrônica e analisadas pelo teste do qui-quadrado, sendo escolhido como critério o nível de significância de 5%. Os resultados mostram, pelas altas prevalências observadas em Bolomys lasiurus e Oligoryzomys nigripes, que estas espécies atuam como reservatório no Cerrado e na Mata Atlântica, respectivamente. Observa-se que a dinâmica ecológica está intimamente relacionada com a transmissão e manutenção de hantavírus na natureza, ficando claro que a atividade reprodutiva é o que mais influencia a ocorrência de roedores soropositivos com cicatrizes, devido às brigas por acasalamento. A prevalência de hantavírus em roedores mostrou-se associada a fatores de idade e sexo, sendo mais comum nos adulto e discretamente mais freqüente nos machos. A sazonalidade da infecção varia de acordo com a espécie de roedor reservatório, sendo que para o Bolomys lasiurus o pico da infecção ocorre no inverno e para Oligoryzomys nigripes, na primavera. Percebeu-se, também, que a prevalência da infecção por hantavírus entre roedores foi maior no Cerrado que na Mata Atlântica, e a sazonalidade dessa prevalência determinou picos na primavera para a Mata Atlântica e no inverno para o Cerrado.

Synovial sarcoma of the extremities: prognostic factors for 20 nonmetastatic cases and a new histologic grading system with prognostic significance.

PURPOSE: To evaluate 20 cases of nonmetastatic synovial sarcoma of the extremities regarding prognostic factors, and to propose a histologic grading system with prognostic significance. METHODS: The cases of 20 patients (14 females and 6 males) with nonmetastatic synovial sarcomas of the extremities treated between 1985 and 1998, were retrospectively evaluated regarding prognostic factors. A histologic grading system with prognostic significance is proposed. RESULTS: The mean follow-up period was 48.4 months (range, 16-116 months). There was local recurrence in 3 cases (15%), microscopic surgical margin being the only prognostic factor identified. Seven patients (35%) died of the disease in a mean postoperative period of 31.7 months (range, 16-53 months), all with pulmonary or brain metastasis. The survival rate was 65% in 48.4 months of follow-up. CONCLUSION: The unfavorable prognostic factors identified regarding survival were high histologic grade, tumors proximal to the knee or elbow, and spontaneous tumor necrosis over 25%. Local recurrence did not have influence on survival in this study. The presence of mast cells appears to have a positive influence on survival, although statistical significance was not reached (P = 0.07). The oncologic and functional result was good in 6 cases (30%), regular in 7 (35%), and poor in 7 cases (35%).

Synovial sarcoma of the extremities: prognostic factors for 20 nonmetastatic cases and a new histologic grading system with prognostic significance

PURPOSE: To evaluate 20 cases of nonmetastatic synovial sarcoma of the extremities regarding prognostic factors, and to propose a histologic grading system with prognostic significance. METHODS: The cases of 20 patients (14 females and 6 males) with nonmetastatic synovial sarcomas of the extremities treated between 1985 and 1998, were retrospectively evaluated regarding prognostic factors. A histologic grading system with prognostic significance is proposed. RESULTS: The mean follow-up period was 48.4 months (range, 16-116 months). There was local recurrence in 3 cases (15 percent), microscopic surgical margin being the only prognostic factor identified. Seven patients (35 percent) died of the disease in a mean postoperative period of 31.7 months (range, 16-53 months), all with pulmonary or brain metastasis. The survival rate was 65 percent in 48.4 months of follow-up. CONCLUSION: The unfavorable prognostic factors identified regarding survival were high histologic grade, tumors proximal to the knee or elbow, and spontaneous tumor necrosis over 25 percent. Local recurrence did not have influence on survival in this study. The presence of mast cells appears to have a positive influence on survival, although statistical significance was not reached (P = 0.07). The oncologic and functional result was good in 6 cases (30 percent), regular in 7 (35 percent), and poor in 7 cases (35 percent).

OBJETIVO: Avaliar casos de sarcoma sinovial não-metastático das extremidades no que se refere a fatores prognósticos, e propor um sistema histológico de pontuação com significado prognóstico. MATERIAL E MÉTODO: Vinte casos (14 do sexo feminino e 6 do sexo masculino) de sarcomas sinoviais não-metastáticos das extremidades tratados entre 1985 e 1998 no departamento de Ortopedia foram avaliados retrospectivamente no que se refere a fatores prognósticos e está sendo proposto um sistema de pontuação histológico com significado prognóstico. RESULTADOS: A média dos períodos de acompanhamento foi 48,4 meses (mínimo 16 meses, máximo 116). Houve recorrência localizada em 3 casos (15 por cento), sendo a margem cirúrgica microscópica o único fator prognóstico identificado. Sete pacientes (35 por cento) morreram da doença, todos em período pós-operatório médio de 31,7 meses (mínimo 16 meses, máximo 53), todos com metástase pulmonar ou cerebral. A sobrevida foi de 65 por cento em 48,4 meses de acompanhamento. CONCLUSÃO: Os fatores prognósticos desfavoráveis identificados referentes à sobrevida foram: grau histológico alto, tumores proximais de joelho ou cotovelo e necrose espontânea de tumor acima de 25 por cento. Neste estudo, a recorrência localizada não influiu na sobrevida. Parece que a presença de mastócitos influi positivamente na sobrevida, porém não obtivemos significado estatístico (p=0,07). O resultado oncológico e funcional foi bom em seis casos (30 por cento), regular em sete (35 por cento) e insatisfatório em sete (35 por cento).