Helping students to understand physiological aspects of regional distribution of ventilation in humans: a experience from the electrical impedance tomography.

Undergraduate biomedical students often have difficulties in understanding basic concepts of respiratory physiology, particularly respiratory mechanics. In this study, we report the use of electrical impedance tomography (EIT) to improve and consolidate the knowledge about physiological aspects of normal regional distribution of ventilation in humans. Initially, we assessed the previous knowledge of a group of medical students ( n = 39) about regional differences in lung ventilation. Thereafter, we recorded the regional distribution of ventilation through surface electrodes on a healthy volunteer adopting four different decubitus positions: supine, prone, and right and left lateral. The recordings clearly showed greater pulmonary ventilation in the dependent lung, mainly in the lateral decubitus. Considering the differences in pulmonary ventilation between right and left lateral decubitus, only 33% of students were able to notice it correctly beforehand. This percentage increased to 84 and 100%, respectively ( P < 0.01), after the results of the ventilation measurements obtained with EIT were examined and discussed. A self-assessment questionnaire showed that students considered the practical activity as an important tool to assist in the understanding of the basic concepts of respiratory mechanics. Experimental demonstration of the physiological variations of regional lung ventilation in volunteers by using EIT is feasible, effective, and stimulating for undergraduate medical students. Therefore, this practical activity may help faculty and students to overcome the challenges in the field of respiratory physiology learning.

Guillain-Barré Syndrome in a Patient Receiving Anti-Tumor Necrosis Factor for Crohn Disease: Coincidence or Consequence?

BACKGROUND Antibodies against tumor necrosis factor alpha (anti-TNF-alpha) are currently widely used in the treatment of inflammatory bowel diseases (IBD), despite a number of reported adverse effects. Diverse neurologic syndromes, including the Guillain-Barre syndrome (GBS), an immune-mediated disease characterized by evolving ascending limb weakness, sensory loss, and areflexia, have been described in association with anti-TNF-alpha therapy. CASE REPORT A 45-year-old White woman was in follow-up with fistulizing ileocolonic Crohn disease using combination therapy (infliximab plus azathioprine) as CD maintenance therapy. After 3 years of this immunosuppressive therapy, she presented with symmetrical and ascending paresis in the lower limbs, and later in the upper limbs, in addition to reduced reflexes in the knees, 1 day after an infliximab infusion. The patient was hospitalized and treatment for CD was suspended. Neurophysiology studies demonstrated a pattern compatible with acute inflammatory demyelinating polyradiculopathy, with predominantly motor involvement, consistent with Guillain-Barre syndrome (GBS). Clinical, laboratory, and imaging exams were unremarkable. She was treated with intravenous immunoglobulins, with a progressive and complete resolution of neurological symptoms. After 1-year follow-up, she presented with active Crohn disease, and we opted for treating her with vedolizumab, with which she achieved clinical and endoscopic remission. CONCLUSIONS Patients receiving biological therapy with anti-TNF-alpha agents should be monitored for central or peripheral neurological signs and symptoms. The development of GBS can be secondary to anti-TNF-alpha treatment. The positive temporal relationship with TNF-alpha therapy and onset of neurological symptoms reinforces this possibility.

Factors associated with surgical resection in patients with Crohn's disease: long-term evaluation.

PURPOSE: To evaluate patient characteristics and factors associated with surgical resection in patients with Crohn's disease (CD). METHODS: An analysis was performed on data from 295 patients with CD in follow-up from 2001 to 2018. Medical record data comprised age, gender, location, behavior and duration of the CD, smoking, and extraintestinal manifestation. Patients were divided into two groups according to the presence or absence of surgical resection. RESULTS: Out of the 295 patients with CD, 155 underwent surgical resection (53.2% male, mean age: 43.88 ± 14.35 years). The main indications for surgery were stenosis (44.5%), clinical intractability (15.5%), and intra-abdominal fistulas (15.5%). Smoking (p < 0.001), longer CD duration (p < 0.0001), ileo-colonic location (p = 0.003), stenosing behavior (p < 0.0001), and fistulizing behavior (p < 0.0001) were significantly associated with surgical resection. Initial use of biological was significantly more frequent in the group of patients without surgical resection (p < 0.001). CONCLUSIONS: Patients with CD still frequently need surgical treatment. Smoking (current or past), longer disease time, stenosing and fistulizing behavior, and ileo-colonic localization in CD patients were associated with a higher risk of surgery. Awareness about factors associated with unfavorable outcome allows such patients to be treated more appropriately.

Relationship between academic performance and affective changes during the first year at medical school.

BACKGROUND: Entering medical school may be associated with changes in the students' life, which can affect academic motivation and impair academic performance. AIMS: This work aimed at measuring longitudinally academic motivation, anxiety, depression and social adjustment in first-year medical students and determining the relationships between these variables and academic performance, as measured mainly by grades on regular exams. METHODS: Eighty-five first-year medical students (age: 17-25 years) were included after giving informed consent. Beck's Anxiety (BAI) and Beck's Depression (BDI) Inventories, the self-reported Social Adjustment Scale (SAS-SR) and the Academic Motivation Scale (AMS) were applied two months after admission and at the end of the academic year. RESULTS: BAI scores increased throughout the year (7.3 ± 6.6 versus 28.8 ± 6.7; p < 0.001), whereas BDI scores did not change (6.8 ± 5.9 versus 6.0 ± 5.4; p > 0.10). SAS-SR subscales scores remained stable, except for a decreasing pattern for leisure/social life (1.8 ± 0.4 versus 2.1 ± 0.4; p < 0.001). AMS scores for motivation to know (22.2 ± 4.5 versus 19.7 ± 5.5; p < 0.001), to accomplish things to know (17.7 ± 5.3 versus 15.4 ± 5.3; p = 0.001), to experience to know (18.2 ± 5.2 versus 15.4 ± 5.4; p < 0.001) and by identification to know (23.5 ± 3.5 versus 21.8 ± 5.0; p = 0.002) decreased significantly. There were no significant correlations between academic performance and the global scores for any of the scales except for the SAS-SR subscale for academic life (r = -0.48, p < 0.001). CONCLUSIONS: Throughout the academic year, first-year medical students showed increased anxiety, decreased academic motivation and a maladjusted leisure/social life, which however does not seem to affect academic achievement.

Dyspeptic symptoms and delayed gastric emptying of solids in patients with inactive Crohn's disease.

BACKGROUND: Patients with Crohn's disease (CD) have been shown to present dyspeptic symptoms more frequently than the general population. Some of these symptoms could be related to motility disorders to some degree. Then, we propose to investigate whether gastric emptying of solids in patients with inactive CD is delayed and to determine the relationships between gastric emptying and dyspeptic symptoms in inactive CD. METHODS: Twenty-six patients with inactive Crohn's disease, as defined by a Crohn's Disease Activity Index (CDAI) < 150, underwent a gastric emptying test by breath test using 13C octanoic acid coupled to a solid meal and answered a validated questionnaire (The Porto Alegre Dyspeptic Symptoms Questionnaire) to assess dyspeptic symptoms. Patients with scores ≥ 6 were considered to have dyspepsia. The control group was composed by 19 age- and sex-matched healthy volunteers. RESULTS: Patients with CD had a significantly longer t 1/2 and t lag (p<0.05) than the controls. CD patients with dyspepsia had significantly (p<0.05) prolonged gastric emptying when compared to patients without dyspeptic symptoms. When the individual symptom patterns were analyzed, only vomiting was significantly associated with delayed gastric emptying (p<0.05). There was no difference between the subgroups of patients with respect to gender, CDAI scores, disease location, clinical behavior (obstructive/obstructive) or previous gastrointestinal surgery. CONCLUSION: Delayed gastric emptying in inactive Crohn's disease patients seems to be associated with dyspeptic symptoms, particularly vomiting, even without any evidence of gastrointestinal obstruction.

PREVALENCE AND PREDICTIVE FACTORS ASSOCIATED WITH POSITIVITY OF SARS-COV-2 SEROLOGICAL MARKERS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE AT AN IBD REFERRAL CENTER.

BACKGROUND: Data related to SARS-CoV-2 exposure rates in patients with inflammatory bowel diseases (IBD) are scarce. Objective - Our aim was to determine the prevalence of serological markers of SARS-Cov-2 and the predictive factors for positivity in patients with IBD. METHODS: This is a cross-sectional, observational study carried out from May to September 2020. SARS-CoV-2 serological markers were determined using chemiluminescence immunoassay in 233 IBD patients without evidence of COVID-19 symptoms. Patient age was 36.6±11.1 years, 118 patients were male (50.6%), and 63.1% had Crohn's disease. Patient clinical data were extracted from individual electronic medical records and complemented by a structured interview. RESULTS: Twenty-six out of the 233 patients with IBD had positive serum markers for SARS-CoV-2 (11.2%). Female sex (P<0.003), extra-intestinal manifestations (P=0.004), use of corticosteroids (P=0.049), and previous contact with individuals with flu-like symptoms (P<0.001) or confirmed diagnosis of COVID-19 (P<0.001), were associated with a significant increased rate of positive SARS-Cov-2 serological markers. No significant difference was observed regarding to adherence to protection measures and positivity of SARS-Cov-2 serological markers (P>0.05). CONCLUSION: SARS-CoV-2 previous infection in IBD patients was not that uncommon, and its prevalence was 11.2% in our series. Positivity to SARS-CoV-2 serological markers was associated with female sex, extra-intestinal manifestations, use of corticosteroids, and contact with individuals with suspected or confirmed COVID-19. Studies with longer follow-up periods are needed to confirm these findings.

COVID-19 quarantine measures are associated with negative social impacts and compromised follow-up care in patients with inflammatory bowel disease in Brazil.

BACKGROUND: COVID-19 has affected the entire world. We aimed to determine the impact of COVID-19 containment measures on the daily life and follow up of patients with inflammatory bowel disease (IBD). METHODS: During May 2020, we evaluated 179 (79.6%) patients with Crohn's disease (CD) and 46 (20.4%) with ulcerative colitis (UC) by telephone, using a structured questionnaire to gather information on social impact and IBD follow up. RESULTS: Some kind of social distancing measure was reported by 95.6% of our patients, self-quarantine (64.9%) being the most frequent. Depressive mood was the most prevalent social impact (80.2%), followed by anxiety/fear of death (58.2%), insomnia (51.4%), daily activity impairment (48%), sexual dysfunction (46.2%), and productivity impairment (44%). The results were similar when we compared patients with active disease to those in remission and patients with UC to those with CD. Analysis of IBD follow up showed that 83.1% of all patients missed an IBD medical appointment, 45.5% of the patients missed laboratory tests, 41.3% missed the national flu vaccination program, 31.3% missed any radiologic exam, 17.3% missed colonoscopy, and 16.9% failed to obtain biologic therapy prescriptions. Biologics were discontinued by 28.4% of the patients. UC patients had higher rates of missed vaccination than CD patients (56.5% vs. 37.4%, P=0.02) and more failures to obtain a biologic prescription (28.3% vs. 14.0%, P=0.02). CONCLUSIONS: Our study reveals alarming social impacts and declining follow-up care for IBD patients during the COVID-19 outbreak. These findings may have implications for disease control in the near future.

Histoplasmosis Related to Immunosuppression in a Patient with Crohn's Disease: A Diagnostic Challenge.

BACKGROUND Infliximab, a monoclonal antibody against tumor necrosis factor (TNF) alpha with proven efficacy and known safety profile, is currently widely used in the treatment of inflammatory bowel diseases. Increased risk for serious infections and malignant neoplasms secondary to immunosuppression is a major concern during therapy with this medication. Histoplasmosis is a granulomatous disease caused by the fungus Histoplasma capsulatum. Disseminated forms of the disease have immunodepression as a major risk factor. CASE REPORT A 39-years-old man had been followed with refractory fistulizing ileocolonic Crohn's disease using combination therapy (infliximab plus azathioprine) and also receiving short courses of steroids. After 2 years of this immunosuppressive therapy, the patient presented with high fever (39.5ºC) for 5 days, associated with profuse sweating, and moderate pain in the left hypochondrium. The patient was hospitalized. Diagnoses of tuberculosis, malignancy, autoimmune diseases, and bacterial and viral infections were rapidly discarded after investigation. Clinical, laboratory, and image signs of liver involvement prompted a guided percutaneous biopsy, which revealed granulomatous hepatitis, with the presence of fungal structures suggestive of Histoplasma capsulatum. Upon treatment with liposomal amphotericin followed by itraconazole, the patient showed an impressively positive clinical response. CONCLUSIONS TNF blockers, particularly when associated with other immunosuppressors, are a serious risk factor for opportunistic infections. This unusual case of disseminated histoplasmosis in a patient with Crohn's disease using infliximab in combination with azathioprine and steroids emphasizes the need for surveillance of this uncommon but potentially lethal complication before starting TNF blockers therapy.

ANEMIA AND IRON DEFICIENCY IN INFLAMMATORY BOWEL DISEASE PATIENTS IN A REFERRAL CENTER IN BRAZIL: PREVALENCE AND RISK FACTORS.

BACKGROUND: Data regarding the prevalence of anemia in inflammatory bowel disease (IBD) patients are scarce in Brazil. Anemia and iron deficiency anemia have been known to cause significant functional impairment, lower quality of life, and higher morbidity and mortality and may be correlated with an impact on the cost of treatment. OBJECTIVE: The aim of this study was to estimate the prevalence and risk factors for anemia and iron deficiency anemia in patients with IBD in a tertiary IBD unit in Southeast Brazil. METHODS: We conducted an Institutional Review Board-approved retrospective analysis of an adult IBD cohort (IBD Unit, Ribeirão Preto Medical School, University of São Paulo, Brazil) consisting of 579 patients between January 2014 and July 2018. Clinicoepidemiological data, hemoglobin measurements and serum ferritin were extracted from electronic medical records. Anemia prevalence was calculated among ulcerative colitis (UC) and Crohn's disease (CD) phenotypes. Risk factors for anemia were also calculated. RESULTS: A total of 529 (91%) patients had complete blood counts available in their medical records. Only 35.5% of IBD patients were fully screened for anemia. The prevalence of anemia in IBD patients was 24.6% (29.1% in CD and 19.1% in UC, P=0.008). The anemia was moderate to severe in 16.9% (19.8% in CD and 11.4% in UC, P=0.34). The prevalence of iron deficiency was 52.3% (53.6% in CD and 51.2% in UC, P=0.95). Anemia of chronic disease was present in 14.1% of IBD patients. A total of 53.8% of patients with anemia were in clinical remission. CD was associated with an increased prevalence of anemia (P=0.008; OR=1.76; CI 95% =1.16-2.66) compared to UC. The penetrant disease phenotype in CD was associated with a lower risk of anemia (P<0.0001; OR=0.25; CI 95% =0.14-0.43). Active disease compared to the disease in clinical remission was associated with an increased risk of anemia (P=0.0003; OR=2.61; CI 95% =1.56-4.36) in CD. The presence of anemia was less frequent in patients with CD who underwent surgical bowel resection compared to those who did not undergo surgery (P<0.0001; OR=0.24; CI 95% =0.14-0.40). No differences in anemia prevalence were observed regarding CD localization, age at diagnosis, UC extension or biological therapy (P>0.05). CONCLUSION: Despite the low levels of full screening, anemia and iron deficiency anemia were common manifestations of IBD. CD was associated with an increased risk of anemia, especially with active disease. In addition, patients with CD who underwent surgical bowel resection and penetrant disease phenotype in CD were associated with lower risk of anemia.

Effect of changes to the formal curriculum on medical students' motivation towards learning: a prospective cohort study.

BACKGROUND: One of the factors known to influence performance in the learning process is student motivation. In turn, students' motivation can be regulated by a large number of variables relating to the individual (such as sex, age and socioeconomic status) or to aspects of the academic life. OBJECTIVE: The primary aim of this study was to evaluate the influence of curriculum changes involving reduction in content overload and increased early exposure to clinical settings, on motivation towards learning among Year 1 medical students. Secondarily, the aim was to ascertain whether this influence on motivation remained stable until the undergraduate program ended (Year 6). DESIGN AND SETTING: Prospective study on two student cohorts at a Brazilian state-owned university. METHODS: Two consecutive student cohorts were assessed: one with a traditional curriculum (n = 87) and the other with a reformed curriculum (n = 63), at the same medical school. Participants in both cohorts gave responses on four scales in Years 1 and 6: the Academic Motivation Scale, containing subscales for autonomous and controlled motivation, and lack of motivation towards learning; Beck's Anxiety and Depression Inventories; Spielberger's State-Trait Anxiety Inventory; and the Social Adjustment Scale. In Year 6, 68% of the initial sample (66 students with the traditional curriculum and 36 with the reformed curriculum) was reassessed. RESULTS: No differences between Year 1 cohorts were found regarding demographic and social background, social adjustment, depression or anxiety. Students with the reformed curriculum scored significantly higher regarding autonomous and controlled motivation than those with the traditional curriculum. Comparison between Year 6 and Year 1 showed increases in controlled motivation only for the traditional curriculum cohort. CONCLUSION: Curriculum changes were associated with increased motivation towards learning in Year 1, which persisted until Year 6.

Perceptions of occupational therapy students and clinical tutors on the attributes of a good role model.

BACKGROUND: Occupational therapy students learn in different environments, where role modelling takes place. Nevertheless, little is known about student and tutors perceptions on model´s characteristics. OBJECTIVES: The aims of this study were to investigate the perceptions of occupational therapy students on the most important attributes of role models and to confront their views with those of clinical tutors. METHODS: A sample of 61 students completed a structured, standardized online questionnaire. Ten clinical tutors regarded by students as good models underwent a semi-structured individual interview. Data were analyzed quantitatively and qualitatively (thematic content analysis). RESULTS: The most important attributes of a good role model according to student perception were: good relationship with patients, integrity and ethical behaviour, respectful relationships with colleagues, patient management skills, commitment to personal and professional growth and enthusiasm for the profession. Clinical tutors believed that they were nominated as good role models because they demonstrated empathy towards patients, good relationships with students and enthusiasm for their profession. CONCLUSIONS AND SIGNIFICANCE: Perceptions of occupational therapy students and clinical tutors about role models characteristics were similar. Identification of attributes of good role models may inform teacher training and faculty development in occupational therapy.

Estresse e Enfrentamento das Dificuldades em Universitários da Área da Saúde / Stress and Coping with Difficulties in Health University Students / Estrés y Enfrentamiento de Dificultades por Universitarios del Sector Salud

Resumo: Este estudo pretende identificar a percepção de estudantes de uma mesma instituição de ensino superior da área da saúde sobre dificuldades acadêmicas e não acadêmicas, estratégias de coping e identificar a presença de estresse. Foi um estudo transversal utilizando abordagens quantitativa e qualitativa, desenvolvido por meio de questionário estruturado e inventários psicométricos validados ( COPE Breve; inventário de sintomas de estresse ISLL ). Adicionalmente, foram realizadas entrevistas para ampliar a compreensão dos resultados dos instrumentos quantitativos. Na etapa quantitativa, participaram 162 estudantes dos cursos de graduação em Fisioterapia, Fonoaudiologia, Medicina, Nutrição e Terapia Ocupacional. Destes, 60 participaram de entrevista qualitativa. Os dados foram submetidos à análise estatística univariada e análise multivariada por regressão logística. Os estudantes relataram encontrar grande número de dificuldades e utilizar variadas estratégias de coping . A análise estatística univariada demonstrou que não houve diferenças importantes entre cursos e etapas quanto ao número de dificuldades e estratégias utilizadas. A presença de estresse foi identificada em proporções entre 45% e 100% dos estudantes, conforme o curso e a etapa considerada, sem diferenças significativas entre eles. A análise multivariada identificou cinco variáveis independentes como determinantes de estresse: sexo feminino, renda familiar, número de dificuldades acadêmicas/não acadêmicas e número de estratégias de coping voltadas à "emoção" presentes. Esta análise também mostrou que o estresse patológico está relacionado a somente uma variável: o número de dificuldades não acadêmicas. Estes achados reforçam a necessidade de manter ações institucionais de assistência social e apoio psicológico, favorecendo assim um planejamento efetivo de medidas de promoção da saúde mental dos estudantes.

Abstract: This study aimed to find undergraduate students' perceptions about academic and non-academic difficulties and coping strategies and determining the occurrence of stress among them. This was a cross-sectional study using quantitative and qualitative approaches to evaluate students from different health professions in a single institution. Physical therapy, speech therapy, medicine, nutrition, and occupational therapy program students (N=162) answered a structured questionnaire and two validated psychometric inventories (COPE Brief scale and the ISS stress symptoms inventory). Additionally, 60 students underwent a semi-structured interview to better understand the results from the quantitative instruments. Quantitative data underwent univariate analysis to test differences between proportions and stepwise multiple regression analysis to identify the independent determinants of stress. Students reported a large number of academic and non-academic difficulties and a variety of coping strategies. Univariate statistical analysis showed no significant differences between courses and stages regarding the number of difficulties and coping strategies. A large proportion of students showed stress, ranging from 45% to 100%, depending on the course and stage, with no significant differences between them. Multivariate statistical analysis found five independent variables as stress determinants: female gender, low family income, number of academic and non-academic difficulties, and number of emotion-focused coping strategies. This analysis also showed that pathological stress is related to only one variable: the number of non-academic difficulties. These findings reinforce the importance of maintaining institutional actions for student social assistance and psychological support. Results also provide meaningful data for adequately planning more effective measures to promote students' mental health.

Resumen: Este estudio pretende identificar la percepción de los estudiantes del sector salud sobre las dificultades académicas y no académicas, las estrategias de coping y la presencia de estrés. Este estudio transversal, con enfoque cuantitativo y cualitativo, utilizó cuestionarios estructurados e inventarios psicométricos validados (escala Brief COPE; inventario de sintomatología de estrés ISE ); además de entrevistas para ampliar la comprensión de los resultados de los instrumentos cuantitativos. En la etapa cuantitativa participaron 162 estudiantes de los cursos de grado en Fisioterapia, Fonoaudiología, Medicina, Nutrición y Terapia Ocupacional. De estos, 60 participaron en la entrevista cualitativa. Los resultados se sometieron a análisis estadístico univaria nte, para distinguir los grupos y asociaciones entre variables, y a análisis multivariado por regresión logística para identificar variables independientes que determinan el estrés. Los estudiantes reportaron enfrentar muchas dificultades académicas y no académicas, y utilizaban diferentes estrategias de coping. El análisis estadístico univariante no obtuvo diferencias significativas entre cursos y etapas respecto al número de dificultades y estrategias utilizadas. Un 45% y 100% de los estudiantes experimentaron estrés según el curso y la etapa considerada, sin diferencias significativas entre ellos. Se encontraron cinco variables independientes como factores de estrés: sexo femenino, renta familiar, número de dificultades académicas/no académicas y número de estrategias de coping orientadas a la "emoción". El estrés patológico estuvo relacionado solo a la variable número de dificultades no académicas. Se necesita mantener acciones institucionales de asistencia social y apoyo psicológico para favorecer una planificación efectiva de medidas de promoción de salud mental de los estudiantes.

Factors associated with surgical resection in patients with Crohn's disease: long-term evaluation

ABSTRACT Purpose: To evaluate patient characteristics and factors associated with surgical resection in patients with Crohn's disease (CD). Methods: An analysis was performed on data from 295 patients with CD in follow-up from 2001 to 2018. Medical record data comprised age, gender, location, behavior and duration of the CD, smoking, and extraintestinal manifestation. Patients were divided into two groups according to the presence or absence of surgical resection. Results: Out of the 295 patients with CD, 155 underwent surgical resection (53.2% male, mean age: 43.88 ± 14.35 years). The main indications for surgery were stenosis (44.5%), clinical intractability (15.5%), and intra-abdominal fistulas (15.5%). Smoking (p < 0.001), longer CD duration (p < 0.0001), ileo-colonic location (p = 0.003), stenosing behavior (p < 0.0001), and fistulizing behavior (p < 0.0001) were significantly associated with surgical resection. Initial use of biological was significantly more frequent in the group of patients without surgical resection (p < 0.001). Conclusions: Patients with CD still frequently need surgical treatment. Smoking (current or past), longer disease time, stenosing and fistulizing behavior, and ileo-colonic localization in CD patients were associated with a higher risk of surgery. Awareness about factors associated with unfavorable outcome allows such patients to be treated more appropriately.

Cytomegalovirus in colorectal cancer and idiopathic ulcerative colitis.

Cytomegalovirus (CMV) is a genus in the family Herpesviridae that has been associated with gastrointestinal syndromes. In this work we looked for a possible association of CMV infection with colorectal cancer and ulcerative colitis (UC). Blood and enteric tissue samples of 14 patients with colorectal cancer and of 21 with UC were subjected to a nested-PCR that amplifies part of the gB gene of CMV and also to immunohistochemistry using a specific monoclonal antibody to IE 76 kDa protein of CMV. CMV was detected by nested-PCR in the blood and/or the enteric tissue of nine (64.3%) colorectal cancer and 16 (76.2%) ulcerative colitis patients. In the immunohistochemistry it was observed that 12 (12/21, 57.1%) positive enteric tissue samples of patients with UC and none from patients with colorectal cancer (0/14) were positive to CMV. The positivity of CMV infections in the UC patient group (12/21, 57.1%) showed by both techniques, was significantly higher (p = 0.015) than that observed for colorectal cancer patients (2/14, 14.3%). These results suggest an association of ulcerative colitis with CMV infection of the enteric tissue.

Estilos de aprendizagem de estudantes de graduação de diferentes profissões da saúde de uma instituição / Learning styles of health professions undergraduate students from a single institution

Resumo: Introdução: O conceito de estilo de aprendizagem deriva de teorias que consideram que as pessoas aprendem de maneiras diversas e que esse processo é melhor quando as estratégias de ensino e aprendizagem adotadas no ambiente escolar são mais compatíveis com algumas das suas características. Objetivo: Este estudo teve como objetivos determinar, em estudantes ingressantes na mesma instituição de ensino superior, em vários cursos de graduação na área da saúde, a frequência dos diferentes estilos de aprendizagem, categorizados segundo as quatro dimensões do referencial de Felder e Soloman (FS), e detectar eventuais diferenças associadas ao tipo de curso e ao gênero. Método: A população de estudo (N = 283; 190 mulheres) foi composta por ingressantes dos cursos de Medicina, Ciências Biomédicas, Fisioterapia, Fonoaudiologia, Nutrição e Metabolismo e Terapia Ocupacional, com 68,2% deles com idade entre 18 e 20 anos. Os estudantes responderam a um questionário de caracterização sociodemográfica e ao Inventário de Estilos de Aprendizagem (ILS) de FS, que permitiu determinar as frequências dos vários estilos de aprendizagem e as suas relações com o tipo de curso de graduação e o gênero. Resultado: No conjunto de estudantes, houve predomínio dos estilos de aprendizagem "sensorial", "visual", "reflexivo" e "sequencial" nas dimensões "percepção", "entrada", "processamento" e "compreensão" da informação, respectivamente. Não houve, em nenhuma das dimensões, diferença estatisticamente significativa quanto aos estilos de aprendizagem que pudesse ser associada ao tipo de curso e ao gênero, embora as mulheres tenham apresentado significativo predomínio do estilo "reflexivo" na dimensão do "processamento". Conclusão: Não foi possível estabelecer diferenças significativas entre os vários cursos de graduação das profissões da saúde, nem entre homens e mulheres, quanto aos estilos de aprendizagem predominantes nos estudantes, embora as mulheres tenham apresentado frequência significativamente maior do estilo reflexivo. Esses achados devem ser levados em consideração no planejamento das atividades de aprendizagem e, principalmente, no apoio pedagógico, dando oportunidade aos estudantes de conhecer os seus estilos de aprendizagem e ajudando-os a se adaptar melhor às estratégias empregadas em cada instituição.

Abstract: Introduction: The concept of "learning styles" derives from theories postulating that students learn by following diverse pathways and that learning is more effective when the adopted teaching strategies more closely match specific student characteristics and learning preferences. Objectives: To determine, in first-year students attending different undergraduate courses in the health area at the same higher education institution, the frequency of different learning styles, categorized according to the four dimensions of Felder & Soloman (FS) model, and to detect any differences associated with the type of course and gender. Method: The study population (N=283; 190 women) consisted of first-year students attending the Medicine, Biomedical Sciences, Physical Therapy, Speech-Language Pathology, Nutrition and Metabolism, and Occupational Therapy courses, with 68.2% of them aged between 18 and 20 years. The students answered a sociodemographic characterization questionnaire and the FS Index of Learning Styles (ILS) questionnaire, which allowed determining the frequencies of the different learning styles and their associations with the type of undergraduate course and gender. Results: the student group showed a predominance of "Sensory", "Visual", "Reflective" and "Sequential", learning styles, in the "Perception", "Input", "Processing" and "Understanding" dimensions of learning, respectively. There was no statistically significant difference in terms of learning styles, in any of the dimensions, that could be associated with the type of course and gender, although women showed a significant predominance of the "Reflective" style in the "Processing" dimension. Conclusion: It was not possible to establish significant differences between the different undergraduate courses in the health area, or between men and women, regarding the students' predominant learning styles, although women showed a significantly higher frequency of the Reflective style. These findings must be considered when planning learning activities and, mainly, in pedagogical support, giving students the opportunity to learn about their learning styles and helping them to better adapt to the strategies employed in each institution.

Reflexões sobre a utilização do Teste de Progresso na avaliação programática do estudante / Reflections on the use of the Progress Test in the programmatic student assessment

Resumo: Introdução: O Teste de Progresso (TP) constitui modalidade estabelecida e bem-sucedida de avaliação de conhecimentos do estudante das profissões da saúde, principalmente os de Medicina, com potencial de contribuir substancialmente para as finalidades formativa e informativa (controle de qualidade e indicação de melhoria nos processos de ensino e aprendizagem). Adicionalmente, o TP apresenta características adequadas à sua inclusão em sistemas institucionais de avaliação que privilegiem a finalidade formativa, como a avaliação programática (AP), mas que cumprem também a somativa. Nas escolas que vêm definindo ações visando à introdução da AP em seus cursos de graduação, é necessária a reflexão sobre as fortalezas e limitações da utilização do TP no sistema de avaliação. Desenvolvimento: A partir das considerações de um grupo de trabalho representativo de toda a instituição, incumbido de propor meios de introdução da AP em um novo currículo para o curso de Medicina, contando com assessoria internacional com experiência tanto no TP como na AP, elaborou-se reflexão sobre esse tema, baseada na experiência dos autores e em dados da literatura. Propõe-se que, dentro da perspectiva longitudinal da AP, o TP constitua um dos pilares na avaliação de conhecimentos. O TP pode servir de base para acompanhamento do estudante, no contexto da sua turma (coorte), e seus resultados devem ser discutidos com o mentor que o acompanha e lhe dá suporte. O TP deve ter também papel central na gestão, como fonte de informações para eventual revisão e qualificação do currículo e das suas atividades de ensino e aprendizagem. É previsível que a utilização do TP na AP traga diferentes desafios e barreiras, que serão mais facilmente superados se houver na instituição experiências já consolidadas de aplicação de exames institucionais e de desenvolvimento docente para a elaboração de questões objetivas de boa qualidade. Conclusão: A efetividade do TP dentro do sistema institucional de AP vai depender de medidas que visem aumentar a sua efetividade na avaliação e que estimulem a participação ativa do estudante, refletindo sobre seu desempenho no TP, com o apoio do seu mentor, de modo a se engajar em ações que fomentem a autorregulação da aprendizagem.

Abstract: Introduction: The Progress Test (PT) is a well-established and mostly successful modality of student knowledge assessment in the health professions, mainly those in the medical area, with the potential to contribute substantially to the formative and informative purposes (quality control and indication of improvement in the teaching-learning processes). Additionally, the PT has characteristics that are adequate for its inclusion in institutional evaluation systems that facilitate the formative purpose, such as programmatic assessment (PA), but that also meet the summative purpose. In schools that have defined actions aimed at introducing PA in their undergraduate courses, it is necessary to reflect on the strengths and limitations of using PT in the evaluation system. Development: based on the considerations of a working group representative of the entire institution, tasked with proposing means of introducing PA in a new curriculum for the medical course, with international advice with experience in both PT and PA, we generated a reflection on this topic, based on the authors' experience and data from the literature. It is proposed that, within the longitudinal perspective of the PA, the PT constitutes one of the pillars in the assessment of knowledge. The PT can be used as a basis for monitoring the students, in the context of their class (cohort), and its results should be discussed with the mentors who accompanies and supports them. The PT must also play a central role in management, as a source of information for eventual review and qualification of the curriculum and its teaching-learning activities. It is predictable that the use of the PT in PA will bring different challenges and barriers, which will be more easily overcome if the institution has already consolidated experiences in the application of institutional exams and in faculty development for the production of good quality objective questions. Conclusion: the effectiveness of the PT within the institutional PA system will depend on measures aimed at increasing its effectiveness in the assessment and that encourage the student's active participation, reflecting on their performance in the PT, with the support of their mentor, aiming to engage in actions that encourage learning self-regulation.

Oficina para elaboração de testes de múltipla escolha de ciências básicas aplicadas: relato de experiência / Workshop on item writing to assess basic sciences in health professional education: an experience report

Resumo: Introdução: A avaliação do estudante é componente essencial de todo programa educacional. O aprendizado das ciências básicas é fundamental para dar sentido ao que se aprende na fase clínica da formação de um profissional em saúde. Entretanto, a maioria dos treinamentos de elaboradores de testes de múltipla escolha (TME) é voltada à formulação de questões clínicas e não inclui abordagem específica para questões das ciências básicas. Relato de experiência: Foi realizada uma oficina para a capacitação docente na elaboração de TME de aplicação dos conhecimentos de ciências básicas, visando à elaboração de uma prova a ser aplicada no final do ciclo básico de seis cursos da saúde. O material instrucional foi elaborado pelos autores, que ofereceram uma oficina no formato on-line. Um diferencial dessa capacitação foi a aplicação de modelos de elaboração de enunciados com contextos definidos, utilizando momentos de preparo assíncronos e encontro síncrono. Após a oficina, aplicaram-se questionários sobre a satisfação e aprendizagem dos participantes. A maioria avaliou a oficina como boa ou muito boa e referiu aumento da percepção de capacidade para elaborar TME, e, ao final, somente 7% se sentiram pouco preparados para elaborar um TME seguindo as boas práticas. Houve melhora na qualidade dos TME elaborados, tendo como referencial os índices de dificuldade e discriminação. Discussão: Existem evidências do valor do desenvolvimento do corpo docente na melhoria da qualidade das questões produzidas. O formato de oficina proposto foi bem avaliado pelos participantes e contribuiu para a qualidade das questões de provas aplicadas ao final do ciclo básico. Conclusão: Estratégias como a descrita qualificam as avaliações dentro da escola e contribuem para a organização de provas externas.

Abstract: Introduction: Student assessment is an essential component of all educational programs. Basic science learning is essential for making clinical knowledge meaningful to healthcare students. However, most item writer training is focused on the formulation of clinical questions and does not include a specific approach to basic science questions. Experience Report: Workshops on item writing for knowledge application on basic sciences were carried out with the aim of planning a test to be applied at the end of the basic cycle of six health courses. The instructional material was prepared by the authors, who offered online workshops. A differential of this training was the application of models of item lead-in elaboration with defined contexts, using moments of asynchronous preparation and synchronous encounter. After each workshop, surveys were applied to assess participants' satisfaction and learning. Most participants rated the workshop as good or very good and reported an increase in their perceived ability to prepare single best answer multiple-choice questions. At the end, only 7% reported they were not prepared to write an item following good practices. There was an improvement in the quality of the items prepared, using the difficulty and discrimination indexes as a reference. Discussion: There is evidence of the value of faculty development in improving the quality of the questions produced. The proposed workshop format was well evaluated by the participants and contributed to the quality of tests applied to students at the end of the basic science cycle. Conclusion: Strategies such this qualify assessments within the school and contribute to the organization of external exams.

[Compliance to drug therapy in inflammatory bowel diseases outpatients from a university hospital]. / Adesão ao tratamento medicamentoso de pacientes com doenças inflamatórias intestinais acompanhados no ambulatório de um hospital universitário.

BACKGROUND: Compliance to drug therapy is important for a successful treatment. Although many studies have assessed compliance to treatment in patients with chronic diseases, few investigations have been carried out in inflammatory bowel diseases. AIM: To assess compliance to drug therapy in patients with inflammatory bowel diseases, Crohn's disease and ulcerative colitis, followed at a university hospital, who had prescribed medication supplied by the Brazilian National Health System. METHODS: In a cross sectional study, a structured interview was applied to assess the compliance of 26 Crohn's disease patients, 26 ulcerative colitis patients and 4 cases with undetermined colitis. Patients were characterized as presenting higher or lower degree of compliance, based on the comparison of the information provided by the patient in the interview and data in the medical records. The Morisky test was also used to assess the behavioral pattern of the patient regarding the daily use of the medication. RESULTS: The interview showed that 15.4% of patients with Crohn's disease and 13.3% of those with ulcerative colitis could be regarded as less compliant. However, the Morisky test revealed lower compliance in 50% of patients with Crohn's disease and 63.3% of those with ulcerative colitis. Univariate analysis showed an association between low compliance and long disease duration, married status and colon involvement in Crohn's disease, and between low compliance and increased disease activity and greater number of medications in ulcerative colitis. However, multivariate analysis did not confirm any association between low compliance and any demographic or clinical factor. CONCLUSIONS: A high degree of noncompliance to treatment, linked to habitual behavior and hard to predict from demographic or clinical factor, was detected in inflammatory bowel disease patients, which suggests the need for investment in patient education regarding medication use.

Characteristics of role models who influenced medical residents to choose surgery as a specialty: exploratory study.

CONTEXT AND OBJECTIVE: Choosing a medical specialty and making decisions concerning a career are difficult processes for medical students and newly graduated physicians.This exploratory study aimed to investigate the influence of role models on the choice of surgery as a career, and to determine the most influential model characteristics. DESIGN AND SETTING: Qualitative analysis on responses to a self-administered questionnaire, in different teaching-learning settings. METHODS: Residents from all years of various surgical subspecialties in a university hospital were included in a survey about the factors that determined their choice of surgery. The questions included items on whether a role model had influenced them in choosing surgery, and the personal or professional characteristics of the models that had been most influential. The responses were subjected to qualitative content analysis. RESULTS: Sixty-four out of 96 medical residents participated. Fifty-three residents (82.8%) acknowledged the influence of role models. Sixteen model characteristics were indicated as important, with 136 mentions. Characteristics classified as technical skills (55%), such as"medical knowledge"and "manual dexterity" predominated over humanistic characteristics (35%), such as "patient-physician relationships" and "ethical behavior". However, this difference was not statistically significant (Fisher test, P = 0.11).There were no age differences regarding the proportions mentioning "technical" and "non-technical" attributes, but female residents mentioned significantly more technical skills than their male colleagues did. CONCLUSIONS: The influence of role models seems to be an important factor determining the choice of surgery as a career. The influential characteristics of the models include not only technical but also humanistic qualities.

Pharmacists' Educational Training and Professional Activities at the Municipal Level of the Brazilian National Health System

Abstract Brazilian pharmacists' education and training aims to prepare them for the various activities they will undertake during professional practice, especially in the national health system (SUS). By using an exploratory transversal study based on a validated questionnaire, we have characterized the educational and training background of pharmacists working in SUS municipal units in Ribeirão Preto, State of São Paulo (SP), Brazil, and the frequency with which these professionals carry out several activities. Pharmacists working in these municipal outpatient units (N=44) graduated between 1981 and 2014 (56.8% of them graduated from public state or federal institutions), are predominantly female (84%), and are aged 25-57 years; 34% of these pharmacists have a "Generalist" degree, and 90.9% attended postgraduate programs, mostly specialization (75%). All the pharmacists pointed out the need for continuing education. The frequency with which they carry out activities varies, but those involving direct contact with patients predominate. Consultations, therapeutic follow-up, case discussions, and health promotion activities take place only occasionally. We concluded that pharmacists who work in the municipality of Ribeirão Preto, SP, are very much involved with dispensing, but not with health education or pharmacotherapeutic follow-up, so investing in education and training in these areas is necessary.