O Currículo de Competências do Programa de Residência em Medicina de Família e Comunidade da Faculdade de Medicina da Universidade de São Paulo / The Competency-based Curriculum of the Residency Program in Family Medicine at Faculdade de Medicina da Universidade de São Paulo / El Currículo de Competencias del Programa de Residencia en Medicina de Familia y Comunidad de la Faculdade de Medicina da Universidade de São Paulo

Objetivo: Apresentar os passos adotados para a construção de um currículo de competências dentro do programa de residência em medicina de família da Faculdade de Medicina da Universidade de São Paulo; descrever características e diretrizes fundamentais do currículo de competências relacionadas aos seus três atributos centrais: ferramentas de aprendizado, metodologias docentes e processos avaliativos; e, por fim, descrever comparações do uso de instrumentos de avaliação pelo nosso programa de residência e outras experiências na literatura. Métodos: Levantamento e análise das principais experiências internacionais em treinamento de médicos de família; realização de uma série de oficinas e workshops; criação de grupos de trabalho com áreas, temas e responsabilidades específicas para estudo, apresentação e definição coletiva. Resultados: Elaboração de um currículo de competências apoiado em um modelo quintidimensional de competências. Conclusão: O estabelecimento de um currículo baseado em competências é vital para organizar o programa de residência. O uso de referenciais internacionais, nacionais e a contribuição das pessoas envolvidas no programa de residência favorecem a organização das competências ao mesmo tempo em que se respeitam as singularidades do programa de residência. Desafios são encontrados para aplicar o currículo na prática do dia-a-dia.

Objective: To present the steps taken to build a competency curriculum in family medicine residency program of the within the Medical School of the University of São Paulo; to describe fundamental characteristics and guidelines of the competency curriculum related to its three central attributes: learning tools, teaching methodologies and evaluation processes; and finally, to describe comparisons of the use of evaluation instruments by our residency program and other experiences in the literature. Methods: Review and analysis of the main international experiences in training of family physicians; conducting a series of workshops and creation of working groups with specific areas, themes and responsibilities for study, presentation and collective definition. Results: Elaboration of a competency curriculum based on a five-dimensional competence model. Conclusion: Establishing a competency-based curriculum is vital to in the organization of the residency program. The use of international and national references and the contribution of the people involved in the residence program favor the organization of competences while respecting the singularities of the residency program. Challenges are encountered in implementing the curriculum in the practice of the day.

Objetivo: Presentar los pasos adoptados para la construcción de un currículo de competencias dentro del programa de residencia en medicina de familia de la Facultad de Medicina de la Universidad de São Paulo; describir características y directrices fundamentales del currículo de competencias relacionadas a sus 3 atributos centrales: herramientas de aprendizaje, metodologías docentes y procesos de evaluación; y por último, describir comparaciones del uso de instrumentos de evaluación por nuestro programa de residencia y otras experiencias en la literatura. Métodos: Levantamiento y análisis de las principales experiencias internacionales en capacitación de médicos de familia; realización de una serie de talleres; creación de grupos de trabajo con áreas, temas y responsabilidades específicas para estudio, presentación y definición colectiva. Resultados: Elaboración de un currículo de competencias apoyado en un modelo de cinco dimensiones de competencias. Conclusión: El establecimiento de un currículo basado en competencias es vital para organizar el programa de residencia. El uso de referencias internacionales, nacionales y la contribución de las personas implicadas en el programa de residencia favorecen la organización de las competencias mientras se respetan las singularidades del programa de residencia. Los desafíos se encuentran para aplicar el currículo en la práctica del día a día.

Induction of micronuclei and sister chromatid exchange in bone-marrow cells and abnormalities in sperm of Algerian mice (Mus spretus) exposed to cadmium, lead and zinc.

As a consequence of human activities, large amounts of cadmium, lead and zinc are released in the environment, often simultaneously. The aim of this study was to investigate under experimental conditions the DNA damage induced in Algerian mice (Mus spretus) exposed to cadmium (Cd), lead (Pb) and zinc (Zn) separately, or in selected combinations. Three cytogenetic end points were considered: the frequencies of micronucleated cells (MN) and sister chromatid exchange (SCE) in the bone marrow and the frequency of sperm abnormalities. Mice were treated by intraperitoneal (i.p.) injections with 5 or 10 doses of aqueous solutions of cadmium acetate, lead acetate and zinc acetate in concentrations corresponding to 1/10 of the LD50, respectively, 21.5, 0.46 and 1.5 mg/kg bw. The control groups were injected in the same way with distilled water. With only one exception (Cd + Zn group treated with 5 doses), the results show a significant increase of MN in all groups for both treatments (5 and 10 doses). Similarly, the results concerning the SCE revealed a statistically significant increase in all treated animals, with the exception of the Zn group treated with 5 doses. The number of sperm abnormalities was significantly higher in animals treated with 5 doses, except in the group Pb + Zn. In animals treated with 10 doses the number of sperm abnormalities was always statistically higher compared with controls. This study indicates that cadmium, lead and zinc can induce MN, SCEs and sperm abnormalities in Algerian mice and that the clastogenic potential is dependent on the time of exposure and the interaction between the three elements, confirming the environmental damage that may result from the simultaneous action of several metals. Most relevant is the toxic potential for Zn, related with the dose, which may compromise its protective effect against other metal contaminations, such as cadmium.

Metallothionein levels in Algerian mice (Mus spretus) exposed to elemental pollution: an ecophysiological approach.

The potential use of metallothioneins (MTs) as biomarkers of trace metal contamination was evaluated for the first time in the Algerian mouse (Mus spretus). Mice were collected seasonally in an abandoned mining area (Aljustrel) and in a reference area, both located in southern Portugal. MT levels were quantified in liver and kidney by differential pulse polarography and hepatic elemental concentrations (Mn, Fe, Cu, Zn, Se) were determined by particle-induced X-ray emission. Hepatic iron and selenium concentrations were elevated in mice from Aljustrel mine when compared to reference animals. MTs levels were averagely higher in mice from Aljustrel than those originated from the reference area. A season-dependent significant effect was found on the hepatic and renal MT concentrations, characterized by higher levels in winter and lower in autumn. In contaminated mice positive relationship between liver elemental contents (Cu in autumn and Fe in winter) and MTs were found. The seasonal variation of MT suggests that probably physiological and environmental factors could influence hepatic and renal MT induction. Results seem to imply that some environmental disturbance occur in the vicinity of the Aljustrel mine. Therefore, for the management purposes MT levels should be followed in liver of M. spretus, especially in winter. Furthermore, other physiological factors that could influence MT expression and turnover in Algerian mouse should also be monitored.

How does the greater white-toothed shrew, Crocidura russula, responds to long-term heavy metal contamination? -- A case study.

Heavy metals accumulation in parallel with the evaluation of physiological and biochemical effects resulting from continued metal exposure were considered here using for the first time the great white-toothed shrew Crocidura russula as an in vivo model. Shrews were originated from an abandoned lead/zinc mining area and from a reference area, both in Alentejo, southern Portugal. Hepatic contents of nickel, copper, zinc, cadmium, mercury and lead were quantified by Inductively Coupled Plasma Mass Spectrometer (ICP-MS). Haematological parameters (white blood cells, red blood cells, haemoglobin and haematocrit) were obtained in a Coulter Counter Analyser and biochemical markers of the redox balance (glutathione S-transferase, glutathione peroxidase, and glutathione reductase) activities were measured spectrophotometrically using a Duo-50 spectrophotometer. Compared with control animals, significantly higher concentration of hepatic cadmium (9.29 vs. 1.18 micorg/g dry weight) and nickel (1.56 vs. 0.343 microg/g dry weight) were detected in the shrews collected in the mining area. However, no significant changes were observed on haematological or enzymatic parameters in animals exposed to metal pollution. The obtained results show that shrews are good bioaccumulators of toxic heavy metals, but very tolerant to their effects, revealing an interesting long-term adaptation to polluted environments. In addition, this study provides reference values for haematological parameters and antioxidant enzymes levels in C. russula, which may be relevant for comparative purposes in further studies.

Metal bioaccumulation in the greater white-toothed shrew, Crocidura russula, inhabiting an abandoned pyrite mine site.

Hepatic and renal concentrations of iron, magnesium, zinc, lead, copper, manganese, mercury, cadmium, molybdenum, chromium, and nickel were quantified in shrews (Crocidura russula) inhabiting a pyrite mine site in Portugal. Several morphological parameters (body weight, residual index, and relative weights) were also examined to clarify the physiological effects of pollution. Shrews from the mine showed increased bioavailability of Fe, Pb, Hg, Cd, Mo, and Ni in comparison with reference specimens. Adult shrews had the highest Cd levels while Cr and Ni concentrations diminished. Intersexual differences were found for Mo and Ni. As a consequence of metal pollution, the relative hepatic weight was higher in shrews from the mine site when compared with reference specimens. These data indicate that C. russula is a good bioindicator of metal pollution. We also evaluated the toxic effects of Pb, Hg, Cd, and Ni, because several shrews from the polluted site showed high concentrations of these metals. To approximate at the real biological impact of abandoned mines, after this first step it is necessary to associate the bioaccumulation levels and morphological effects with other physiological, ecological and genetical biomarkers.