Risk of osteoporotic fracture in women using the FRAX tool with and without bone mineral density score in patients followed at a tertiary outpatient clinic ‒ An observational study

ABSTRACT Objectives: Fragility fractures increase morbidity and mortality. Adding assessment of clinical risk factors independently or as a previous step to Bone Densitometry (BD) should provide better accuracy in fracture risk prediction. FRAX tool might be used to stratify patients in order to rationalize the need for BD and risk classification. The primary objective of this study is to describe and perform comparisons between the estimated risk of fractures in 10 years using the FRAX calculator based on clinical factors with and without BD results for women aged 40 or more with clinical diseases monitored in tertiary care service in internal medicine. Methods: Cross-sectional. Women over 40 years with BD in the previous year. After medical chart review, identification of risk factors and risk estimations using FRAX-BRAZIL with (FRAX BDI) and without (FRAX BDNI) the inclusion of T-score. Results: 239 women. Age 65 ± 10.35 years. BMI 29.68 ± 6.27kg/m2. Risk factors: 32(13.4%) previous fractures; 23 (9.6%) current smoking; 78 (32.6%) corticosteroids use; 44 (18.4%) rheumatoid arthritis; 38 (15.9%) secondary causes; FRAX scores were higher when BD was not included. Spearman correlation coefficients between FRAX BDNI and FRAX BDI for major fractures r = 0.793 (95% CI 0.7388‒0.836). For hip fractures r = 0.6922 (95% CI 0.6174‒0.75446) Conclusion: Using FRAX to estimate 10-year fracture risk without BD data might be a reliable tool for screening, even for patients with a high prevalence of risk factors, improving accessibility and equity in health systems. The present study's data suggest an overestimation of fracture risk with FRAX BDNI, suggesting that it is safe to be widely used as a screening tool.

Perception of usefulness of laboratory tests ordering by internal medicine residents in ambulatory setting: A single-center prospective cohort study.

The demand for high value health care uncovered a steady trend in laboratory tests ordering and inappropriate testing practices. Residents' training in laboratory ordering practice provides an opportunity for quality improvement. We collected information on demographics, the main reason for the appointment, preexisting medical conditions and presence of co-morbidities from first-visit patients to the internal medicine outpatient service of our university general hospital. We also collected information on all laboratory tests ordered by the attending medical residents. At a follow-up visit, we recorded residents' subjective perception on the usefulness of each ordered laboratory test for the purposes of diagnosis, prognosis, treatment or screening. We observed that 17.3% of all ordered tests had no perceived utility by the attending resident. Tests were usually ordered to exclude differential diagnoses (26.7%) and to help prognosis estimation (19.1%). Age and co-morbidity influenced the chosen category to legitimate usefulness of tests ordering. This study suggests that clinical objectives (diagnosis, prognosis, treatment or prevention) as well as personalization to age and previous health conditions should be considered before test ordering to allow a more appropriate laboratory tests ordering, but further studies are necessary to examine this framework beyond this medical training scenario.

Improving serum calcium test ordering according to a decision algorithm.

AIM: To detect differences in the pattern of serum calcium tests ordering before and after the implementation of a decision algorithm. METHODS: We studied patients admitted to an internal medicine ward of a university hospital on April 2013 and April 2016. Patients were classified as critical or non-critical on the day when each test was performed. Adequacy of ordering was defined according to adherence to a decision algorithm implemented in 2014. RESULTS: Total and ionised calcium tests per patient-day of hospitalisation significantly decreased after the algorithm implementation; and duplication of tests (total and ionised calcium measured in the same blood sample) was reduced by 49%. Overall adequacy of ionised calcium determinations increased by 23% (P=0.0001) due to the increase in the adequacy of ionised calcium ordering in non-critical conditions. CONCLUSIONS: A decision algorithm can be a useful educational tool to improve adequacy of the process of ordering serum calcium tests.

Alcohol and tobacco use and the diseases treated in general practice / Uso de álcool e tabaco e as doenças tratadas em ambulatório de clínica geral

Summary Objective: To characterize the use of alcohol and tobacco and correlate both to the diseases of outpatients in a general practice outpatient clinic. Method: The ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) questionnaire was answered by 300 randomly chosen subjects assigned to different groups according to the diseases being treated at the Outpatient General and Teaching Clinic of the Department of Internal Medicine, Hospital das Clínicas of the University of São Paulo's School of Medicine (HC-FMUSP, in the Portuguese acronym), São Paulo, Brazil. The consumption of tobacco and alcohol was characterized and its correlation with the groups of diseases being treated was calculated using Chi-square and Pearson test statistics. Results: Compared to alcohol, tobacco use was more prevalent, more intense and showed more health-, social-, legal- and financial-related damage. Tobacco smoking presented a positive significant (p<0.0001) correlation with respiratory diseases. According to the questionnaire's criteria, few alcohol users would be referred to clinical interventions in comparison to smokers. Conclusion: Respiratory diseases and tobacco use were well correlated based on the ASSIST questionnaire. The preventive value of the questionnaire was more evident in relation to tobacco than alcohol consumption.

Resumo Objetivo: Caracterizar o consumo de álcool e tabaco e correlacioná-lo às doenças em tratamento de pacientes de um ambulatório de clínica geral. Método: As perguntas do ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) foram respondidas por 300 pacientes escolhidos aleatoriamente e enquadrados em grupos conforme os diagnósticos das doenças em tratamento no Ambulatório Geral e Didático (AGD), Serviço de Clínica Geral do HC-FMUSP; o consumo das substâncias foi caracterizado e a sua correlação com as doenças em tratamento foi calculada por meio do método do Qui-quadrado e teste de Pearson. Resultados: O consumo de tabaco mostrou-se mais prevalente, mais intenso e maior causa de complicações (de saúde, sociais, legais ou financeiras) do que o do álcool; o consumo de tabaco apresentou correlação positiva e significante (p<0,0001) com a referência de doença respiratória no prontuário médico. De acordo com o critério proposto no questionário, poucos consumidores de bebida alcoólica seriam encaminhados para intervenção preventiva, ao contrário do que ocorreria com os fumantes. Conclusão: A aplicação do ASSIST permitiu caracterizar e correlacionar positivamente o uso de tabaco com doenças respiratórias em tratamento. A importância do questionário como instrumento preventivo das consequências do tabagismo ficou mais evidente do que em relação às associadas ao consumo de bebida alcoólica.

Laboratory Tests Ordering Pattern by Medical Residents From a Brazilian University Hospital.

OBJECTIVES: The adequacy of laboratory test orders by medical residents is a longstanding issue. The aim of this study is to analyze the number, types, and pattern of repetition of tests ordered by medical residents. METHODS: We studied all tests ordered over a 1-year period for inpatients of an internal medicine ward in a university hospital. Types, results, and repetition pattern of tests were analyzed in relation to patients' diagnoses. RESULTS: We evaluated 117,666 tests, requested for 1,024 inpatients. The mean number of tests was 9.5 per day. The test repetition pattern was similar, regardless of patients' diagnoses, previous test results, or duration of stay. The probability of an abnormal result after a sequence of three normal tests was lower than 25%, regardless of the diagnosis. CONCLUSIONS: Number of tests and repetition were both high, imposing costs, discomfort, and risks to patients, thus warranting further investigation.

Glenoumeral dislocation: a prospective randomized study comparing spazo and kocher maneuvers

OBJECTIVE: To evaluate and to compare the Spaso and Kocher reduction maneuvers in terms of efficiency, time of reduction, facileness, pain, discomfort to the patient, complications and risks, besides promoting the comparison between the two maneuvers, aiming to ground the emergency conduct. METHODS: A prospective study with 105 patients with acute shoulder dislocations were enrolled in the study between February 2011 and September 2012. The patients were randomized into two groups and they were submitted to the reduction of dislocation using the Spaso maneuver (group A) or the Kocher technique (group B) by first, second or third-year orthopedic surgery residents from our service. The results were evaluated and compared. RESULTS: There was no statistically significant difference between the two groups in terms of age, gender, timing of reduction, number of precedent episodes and complications after reduction. However, reduction was achieved in more cases using the Spaso method than it was among the Kocher group, as well as the mean duration of the reduction maneuver and discomfort were shorter in the group A patients. CONCLUSIONS: Both methods presented good results in terms of dislocation reduction and low complications rates. Nevertheless, the Spaso maneuver was more efficient, fast and easily applicable in comparison with Kocher's method. Level of Evidence I, Therapeutic.

Rational use of blood calcium determinations.

CONTEXT AND OBJECTIVE: This study was motivated by the recent excessive increase in requests for blood calcium determinations and laboratory tests in general, in the Hospital das Clínicas complex of Faculdade de Medicina, Universidade de São Paulo (HCFMUSP). Its aim was to suggest rules for the determination of total and ionized calcium in our intensive care units, emergency department, wards and outpatient services, thus contributing towards improving the quality of medical care and achieving more appropriate use of human and financial resources. DESIGN AND SETTING: Critical analysis on clinical and laboratory data and the pertinent scientific literature, conducted by the study group for rational clinical laboratory use, which is part of the Central Laboratory Division, HCFMUSP. METHODS: The study group reviewed scientific publications, statistics and clinical and laboratory data concerning requests for total and ionized calcium determinations in the settings of intensive care units, emergency department, wards and outpatient services. RESULTS: From this critical analysis, clinical decision flow diagrams aimed at providing guidance for ordering these tests were constructed. CONCLUSIONS: Use of the proposed flow diagrams may help to limit the numbers of inappropriate requests for ionized and total calcium determinations, with consequent reductions in the number of tests, risks to patients and unnecessary costs.

Rational use of blood calcium determinations / Uso racional da dosagem de cálcio no sangue

CONTEXT AND OBJECTIVE: This study was motivated by the recent excessive increase in requests for blood calcium determinations and laboratory tests in general, in the Hospital das Clínicas complex of Faculdade de Medicina, Universidade de São Paulo (HCFMUSP). Its aim was to suggest rules for the determination of total and ionized calcium in our intensive care units, emergency department, wards and outpatient services, thus contributing towards improving the quality of medical care and achieving more appropriate use of human and financial resources. DESIGN AND SETTING: Critical analysis on clinical and laboratory data and the pertinent scientific literature, conducted by the study group for rational clinical laboratory use, which is part of the Central Laboratory Division, HCFMUSP. METHODS: The study group reviewed scientific publications, statistics and clinical and laboratory data concerning requests for total and ionized calcium determinations in the settings of intensive care units, emergency department, wards and outpatient services. RESULTS: From this critical analysis, clinical decision flow diagrams aimed at providing guidance for ordering these tests were constructed. CONCLUSIONS: Use of the proposed flow diagrams may help to limit the numbers of inappropriate requests for ionized and total calcium determinations, with consequent reductions in the number of tests, risks to patients and unnecessary costs. .

CONTEXTO E OBJETIVO: Este trabalho foi motivado pelo recente aumento excessivo de solicitações de dosagem de cálcio no sangue, assim como de exames laboratoriais em geral, no complexo do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). Seu objetivo foi sugerir regras para a determinação de cálcio total e iônico nas nossas unidades de terapia intensiva, pronto-socorro, enfermarias e ambulatórios e contribuir para a melhoria da qualidade da assistência médica, com utilização mais adequada dos recursos humanos e financeiros. TIPO DO ESTUDO E LOCAL: Análise crítica de dados clínicos, laboratoriais e da literatura médica pertinente, realizada pelo grupo de estudos para o uso racional do laboratório clínico, vinculado à Divisão de Laboratório Central do HCFMUSP. MÉTODOS: O grupo de estudos reviu publicações científicas, estatísticas e dados clínico-laboratoriais relativos às solicitações de cálcio total e iônico nos ambientes das unidades de terapia intensiva, prontos-socorros, enfermarias e ambulatórios. RESULTADOS: A partir dessa análise crítica, foram construídos fluxogramas de decisão clínica que visam orientar a requisição desses testes. CONCLUSÕES: A utilização dos fluxogramas propostos pode ajudar a limitar a solicitação inadequada das dosagens de cálcio total e iônico, com consequente redução do número de exames, de riscos para os pacientes e de custos desnecessários. .

Comparação dos hábitos pessoais e conhecimento basal de promoção de saúde entre alunos do primeiro ano do Curso de Especialização de Medicina do Trabalho (Turma 2011), alunos residentes e internos do quinto ano da Faculdade de Medicina da USP / Comparison of personal habits and baseline knowledge of health promotion among students of the Faculty of Medicine, University of São Paulo

Durante os anos de graduação do curso de medicina pouca ênfase é dada à importância da promoção e prevenção de saúde na vida dos médicos e pacientes. Este trabalho foi desenvolvido para avaliar o conhecimento basal dos alunos de especialização em medicina do trabalho sobre promoção de saúde e correlacioná-lo com o conhecimento basal dos alunos da Faculdade de Medicina da Universidade de São Paulo (internos do quinto ano e residentes do primeiro ano de clínica médica) além de avaliarmos os seus próprios hábitos de saúde. Para isto fizemos uma revisão bibliográfica de 1997 a 2011 sobre o tema, nas bases de dados online. Foi realizado um estudo transversal no qual foram aplicados dois questionários que já haviam sido utilizados em estudos anteriores por Ferreira Junior, 2011. Os questionários forma denominados 1) “Questionário de atitudes e Comportamento” e 2) “Questionário de avaliação de conhecimento em promoção de saúde”. No questionário 1 as médias menores dos alunos da pós-graduação se apresentaram nos itens uso de cigarro e drogas, situações de estresse, comportamento sexual, qualidade do sono, vacinação e check up atuais, sendo que a expectativa para o próximo ano se manteve menor nos itens uso de drogas, estresse e prevenção de acidentes e violência. As notas maiores entre os pós-graduandos, foram relacionadas à alimentação e higiene bucal, tanto no momento atual como a expectativa para daqui um ano. As questões sobre atitude profissional, nos seus 13 itens as notas dos pós-graduandos foram maiores no item Capacitação. Nos demais itens, as notas dos alunos da graduação e da residência médica, e dos alunos da pós-graduação foram iguais. Quando comparadas as médias dos alunos da pós-graduação no chamado questionário 2, todos os itens apresentaram valores menores em relação às notas de internos e residentes. De acordo com os resultados obtidos observamos certo menosprezo com os temas relacionados a promoção da saúde...

During the years of the undergraduate medical course little emphasis is given to the importance of health promotion and prevention in the lives of doctors and patients. Typically, the teaching is based on a curative medicine. But, nowadays, the implementing health promotion programs are important to generate significant positive results for society and especially for businesses, employees and the financial market. This study aims to increase the sample size of a monograph made in 2011 and evaluate health promotion knowledge of first year’s students of specialization in Occupational Medicine, correlating it with the knowledge of the second year’s students of specialization in Occupational Medicine of Medicine College of São Paulo University, after Health Promotion module, and evaluate their own health habits. We’ll do a literature review from 1997 to 2014 on the topic in the online databases. A cross-sectional study will be done with two questionnaires that had been used in previous studies by Ferreira Junior 2011. Questionnaires are called 1) “Survey of attitudes and behavior” and 2) “Questionnaire of knowledge will be held in promoting health.” Then, statistical analysis will be made with data obtained by questionnaires and through the evaluation of results we’ll conclude the study.

Avaliação de tecnologias educacionais digitais para a formação de promotores de saúde em uma experiência interprofissional / Evaluation of educational technologies to human resources formation about health promotion in an interprofessional experience

Objetivos: Descrever e analisar a utilização de recursos didáticos digitais em experiência semipresencial de formação interprofissional em promoção da saúde, com e sem apoio de tutoria. Materiais e Métodos: : A população foi constituída por 211 alunos de três edições do Curso “Práticas em Promoção da Saúde” da Faculdade de Medicina da USP. Os recursos, desenvolvidos com softwares livres, foram: blog, grupo de e-mails e palavras-cruzadas, oferecidos igualmente em 2007 e 2008, porém neste último ano associados a um trabalho de tutoria. O impacto na aprendizagem foi avaliado qualitativamente, por meio de grupo focal e quantitativamente, por meio de contadores próprios dos softwares de blog e grupo de e-mails. Resultados: Maior utilização das tecnologias ao longo do curso, sendo que a tutoria e a proximidade das provas aumentaram a média de visitas ao blog, do número de alunos participantes no grupo de e-mails e do número de mensagens enviadas. A avaliação quali-quantitativa mostrou impacto dos recursos didáticos no domínio do aprender a conhecer. Conclusão: A utilização do blog e grupo de e-mails aumentou durante o estudo, sobretudo com foco no conteúdo. Por outro lado, a tutoria somada aos recursos didáticos voltados à interação mostraram diferenças significativas nas formas de troca no grupo de e-mails, o que pode ser relacionado com o aprender a conviver.

Aims: To describe and analyze the use of digital learning resources in an experience of interprofessional education in health promotion, with and without support mentoring. Materials and Methods: The study population consisted of 211 students from three editions of Course “Practices in Health Promotion “, Faculty of Medicine, USP. Resources, developed with open source software, were: blog, emails based groups and crosswords, all offered in 2007 and 2008, but this last year associated with a mentoring. The impact on learning was assessed qualitatively through focus groups and quantitatively, through the own blog software and groups counters. Results: Increased use of technologies throughout the course and the mentoring and the proximity of assessment increased the average blog visits, the number of students participating in emails based groups and the number of messages sent. The qualitative and quantitative evaluation shows impact of educational resources in the field of learning to know. Conclusion: The use of the blog and the email based group increased during the study, especially focusing on the content. Moreover, mentoring added to the teaching resources aimed at interaction showed significant differences in the forms of exchange in the group e- mails, which may be related to learn to live together.

Vitamin D: non-skeletal actions and rational use.

Recent years have witnessed a substantial increase in the number of seric determinations of vitamin D, in a worldwide basis. At Hospital das Clínicas of Faculdade de Medicina of Universidade de São Paulo that increase reached 700% over the last four years. Nevertheless there are many controversies on the literature about the role of vitamin D in conditions unrelated to the musculoskeletal system. In this study the metabolism, sources and actions of vitamin D on the body are reviewed. Observational studies, clinical trials, systematic reviews and metanalysis which focused on the relationship between the vitamin and conditions such as cancer, cardiovascular disease, diabetes and falls were searched on the literature, analyzed and discussed. Results are presented as quiz and answer, tables and a figure. The role of vitamin D on the above-mentioned conditions is discussed, and the controversial issues stressed.

Vitamina D: ações extraósseas e uso racional / Vitamin D: non-skeletal actions and rational use

O número de dosagens do nível sérico de vitamina D tem apresentado crescimento muito expressivo nos últimos anos em todo o mundo. No Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo houve aumento de cerca de 700% em quatro anos nas solicitações desse hormônio. No entanto, há controvérsias na literatura sobre a real utilidade de sua dosagem e/ou suplementação, exceto em situações diretamente relacionadas ao metabolismo ósseo. No presente trabalho são revistos o metabolismo, as fontes e as ações da vitamina D no organismo. Estudos observacionais, ensaios clínicos, revisões sistemáticas e metanálises, cujo foco é a relação entre vitamina D e doenças ou condições clínicas, como câncer, doenças cardiovasculares, diabetes e quedas, foram pesquisados na literatura, analisados e discutidos. Os resultados estão apresentados em forma de perguntas e respostas, tabelas e figura. Discute-se o papel da vitamina D em todas essas situações, e salientam-se os pontos controvertidos.

Recent years have witnessed a substantial increase in the number of seric determinations of vitamin D, in aworldwide basis. At Hospital das Clínicas of Faculdade de Medicina of Universidade de São Paulo that increase reached 700% over the last four years. Nevertheless there are many controversies on the literature about the role of vitamin D in conditions unrelated to themusculoskeletal system. In this study the metabolism, sources and actions of vitamin D on the body are reviewed. Observational studies, clinical trials, systematic reviews and metanalysis which focused on the relationship between the vitamin and conditions such as cancer, cardiovascular disease, diabetes and falls were searched on the literature, analyzed and discussed. Results are presented as quiz and answer, tables and a figure. The role of vitamin D on the above-mentioned conditions is discussed, and the controversial issues stressed.

Tele-educação e monitoria ativa no ensino da saúde bucal a estudantes de medicina / Tele-education and active monitoring on oral health education for medical students

OBJETIVOS: Verificar o nível de conhecimento basal de alunos do quinto ano de Medicina sobre saúde bucal e mensurar os ganhos em conhecimento e a habilidade de aconselhamento após treinamento. MÉTODOS: Cento e quarenta e oito alunos, divididos em quatro turmas - 2007-A (grupo controle), 2007-B, 2008-A e 2008-B - receberam intervenções progressivas de ensino, presenciais (em 2007) e a distância (em 2008). A turma 2008-B recebeu também contatos ativos com especialista em saúde bucal. O ganho em conhecimento foi medido por provas escritas aplicadas antes e depois da respectiva intervenção, e a habilidade em aconselhar foi avaliada por meio do exame clínico objetivo estruturado por estações (Osce). RESULTADOS: Noventa e um por cento dos alunos acharam inadequado o seu nível basal de conhecimento em promoção da saúde bucal. O ganho de conhecimento das turmas 2008-A e 2008-B foi progressivo e estatisticamente superior ao do grupo controle, assim como ocorreu com a habilidade de aconselhamento da turma 2008-B. CONCLUSÃO: As informações obtidas no presente estudo podem ser úteis para o desenvolvimento de estratégias de ensino interdisciplinar em áreas complementares da formação médica.

OBJECTIVES: To verify the baseline level of knowledge among medical students in the fifth year of the degree course regarding the practice of oral health and to measure the increase in knowledge and counseling skills after training. METHOD: 148 students, divided into 4 groups - 2007-A (control group), 2007-B, 2008-A and 2008-B - received progressive training interventions, face to face (2007) and online (2008). The 2008-B group also had active contact with a specialist in oral health. Increases in knowledge were measured by written assessments applied before and after the respective intervention, and counseling skills were assessed through the Objective Structured Clinical Examination (OSCE) . RESULTS: 91% of the students found their baseline knowledge of oral health promotion insufficient. The growth in knowledge of groups 2008-A and 2008-B was significant when compared to the control group. The 2008-B group also demonstrated an increased ability to provide advice on oral health. CONCLUSION: the information obtained in this study may be useful for developing strategies for interdisciplinary teaching in complementary areas of medical training.

C-reactive protein: clinical applications and proposals for a rational use.

C-reactive protein (CRP) is an acute-phase protein whose requests have been growing exponentially in several countries, including Brazil. In this study, the use of CRP in several clinical situations was reviewed by a group of physicians comprised by specialists in internal medicine, medical emergencies, intensive care, screening, and laboratory medicine, aiming to analyze the applicable literature and to propose guidelines for a more rational use of this laboratory test. The result was the creation of flowcharts guiding CRP request, adjusted to four different healthcare environments, namely, intensive care units, emergency room, wards, and outpatient clinics. These flowcharts, as well as a more detailed discussion on several clinical recommendations for the test, are presented in this study.

Proteína C reativa: aplicações clínicas e propostas para utilização racional / C-reactive protein: clinical applications and proposals for a rational use

A proteína C reativa (PCR) é uma das proteínas de fase aguda cuja solicitação tem crescido de forma exponencial em vários países, incluindo o Brasil. Neste estudo, a utilidade da PCR em diversas situações clínicas foi revisada por um grupo de médicos composto por especialistas em Medicina Interna, Emergências Médicas, Terapia Intensiva, Rastreamento e Medicina Laboratorial com o objetivo de analisar a literatura pertinente e propor diretrizes para o uso mais racional desse exame laboratorial. O resultado foi a criação de fluxogramas orientadores da solicitação de PCR adaptados a quatro ambientes assistenciais diferentes, sendo eles unidades de terapia intensiva, pronto-socorro, enfermarias e ambulatórios. Esses fluxogramas e uma discussão mais detalhada sobre as diversas indicações clínicas do exame são apresentados neste estudo.

C-reactive protein (CRP) is an acute-phase protein whose requests have been growing exponentially in several countries, including Brazil. In this study, the use of CRP in several clinical situations was reviewed by a group of physicians comprised by specialists in internal medicine, medical emergencies, intensive care, screening, and laboratory medicine, aiming to analyze the applicable literature and to propose guidelines for a more rational use of this laboratory test. The result was the creation of flowcharts guiding CRP request, adjusted to four different healthcare environments, namely, intensive care units, emergency room, wards, and outpatient clinics. These flowcharts, as well as a more detailed discussion on several clinical recommendations for the test, are presented in this study.

Risk factors for computer visual syndrome (CVS) among operators of two call centers in São Paulo, Brazil.

The aims of this study were to investigate work conditions, to estimate the prevalence and to describe risk factors associated with Computer Vision Syndrome among two call centers' operators in São Paulo (n = 476). The methods include a quantitative cross-sectional observational study and an ergonomic work analysis, using work observation, interviews and questionnaires. The case definition was the presence of one or more specific ocular symptoms answered as always, often or sometimes. The multiple logistic regression model, were created using the stepwise forward likelihood method and remained the variables with levels below 5% (p < 0.05). The operators were mainly female and young (from 15 to 24 years old). The call center was opened 24 hours and the operators weekly hours were 36 hours with break time from 21 to 35 minutes per day. The symptoms reported were eye fatigue (73.9%), "weight" in the eyes (68.2%), "burning" eyes (54.6%), tearing (43.9%) and weakening of vision (43.5%). The prevalence of Computer Vision Syndrome was 54.6%. Associations verified were: being female (OR 2.6, 95% CI 1.6 to 4.1), lack of recognition at work (OR 1.4, 95% CI 1.1 to 1.8), organization of work in call center (OR 1.4, 95% CI 1.1 to 1.7) and high demand at work (OR 1.1, 95% CI 1.0 to 1.3). The organization and psychosocial factors at work should be included in prevention programs of visual syndrome among call centers' operators.

The three factor eating questionnaire - R21: tradução para o português e aplicação em mulheres brasileiras / The three factor eating questionnaire - R21: translation and administration to Brazilian women

OBJETIVO: Analisar e discutir a relação dos comportamentos de restrição cognitiva, alimentação emocional e descontrole alimentar entre si e com os parâmetros antropométricos: índice de massa corporal e circunferência abdominal. MÉTODOS: Tradução para o português e aplicação do The Three Factor Eating Questionnaire - versão reduzida de 21 itens, com subsequente comparação aos parâmetros antropométricos de 125 mulheres trabalhadoras do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, escolhidas casualmente em um grupo de 800 interessados em orientação nutricional. RESULTADOS: Encontraram-se associações entre a alimentação emocional e o descontrole alimentar, além de associações entre alimentação emocional e descontrole alimentar, índice de massa corporal e circunferência abdominal. CONCLUSÃO: O The Three Factor Eating Questionnaire - versão reduzida de 21 itens mostrou-se um instrumento adequado para identificar os comportamentos de restrição cognitiva, alimentação emocional e descontrole alimentar, padrões de comportamentos cuja análise pode servir como ponto de partida para a adoção de estratégias de abordagem de orientação nutricional em programas de controle de peso.

OBJECTIVE: This study analyzed and discussed how cognitive restraint, emotional eating and bingeing behaviors interrelate and relate with the anthropometric parameters BMI and waist circumference. METHODS: The short version of The Three Factor Eating Questionnaire consisting of 21 items was translated into Portuguese, administered to 125 female employees from the Central Unit of the Universidade de São Paulo School of Medicine Clinics Hospital and compared with the anthropometric data of these women who had been casually selected from a group of 800 individuals interested in nutrition counseling. RESULTS: Emotional eating was found to be associated with bingeing, body mass index and waist circumference. CONCLUSION: The short version of The Three Factor Eating Questionnaire with 21 items proved to effectively identify cognitive restraint, emotional eating and bingeing behaviors. Analysis of these behavior patterns can be the starting point for the implementation of strategies for approaching nutrition counseling in weight-control programs.

Relações disciplinares em um centro de ensino e pesquisa em práticas de promoção da saúde e prevenção de doenças / Disciplinary relationships in a university center for education and research in health promotion and disease prevention in clinical practice

O trabalho em equipe interdisciplinar é considerado um importante pressuposto para reorganização do processo de trabalho com práticas de promoção da saúde e prevenção de doenças, visando a uma abordagem mais integral e resolutiva. Neste artigo avaliam-se as relações disciplinares entre profissionais de saúde a partir do estudo de caso de um centro universitário voltado ao ensino e pesquisa em práticas de promoção da saúde e prevenção de doenças. Com base na visão humanista das relações disciplinares, procurou-se identificar as principais premissas que determinam o trabalho interdisciplinar. Utilizaram-se os métodos da observação participante e entrevistas semi-estruturadas com profissionais de saúde, seguidas da análise de conteúdo na modalidade temática, para a coleta e interpretação dos dados. A análise revelou que o serviço de saúde avaliado apresentava uma situação possivelmente transitória da pluri para a interdisciplinaridade. Partindo-se do estudo de caso, discutem-se os fatores sociais, culturais, educacionais, institucionais e subjetivos que podem agir tanto como facilitadores quanto como obstáculos à interdisciplinaridade.

Webliografia básica em promoção da saúde e prevenção de doenças / Basic webliography on health promotion and disease prevention

Objetivos: Apresentar uma webliografia básica que dê acesso a material cientificamentequalificado na área de promoção da saúde e prevenção de doenças, visando à educaçãocontinuada de profissionais de saúde. Métodos: Por meio do rastreador Google®, usandodescritores em sequência para refinamento progressivo de busca na Internet e conceitosmarcadores a serem aprendidos, todos predefinidos pelos próprios autores, procedeu-se àanálise qualitativa dos 20 primeiros endereços eletrônicos listados por busca e seleção delinks com material cientificamente relevante sobre cada assunto. Resultados: Os 34 linksselecionados são apresentados em 4 grupos: 23 portais temáticos, 5 guias e recomendações,4 periódicos científicos e 3 blogs, que dão acesso livre a temas gerais e específicos empromoção da saúde e prevenção de doenças, incluindo: conceitos; políticas públicas nacionaise internacionais; epidemiologia, estatísticas e indicadores de saúde; rastreamento e profilaxiade doenças; aconselhamento para mudanças comportamentais de hábitos ligados à saúde;e trabalho interdisciplinar em saúde. Destes, 10 (29%) estão escritos em idioma inglês e orestante em português. Conclusões: A identificação de material de leitura sobre promoção dasaúde e prevenção de doenças disponível online na Internet, boa parte em português, permitiuselecionar literatura relevante, cientificamente qualificada, e torná-la acessível a profissionaisde saúde, possibilitando a aquisição de novos conhecimentos ou rápidas atualizações.

[Speech tests: application in individuals with noise induced hearing loss]. / Testes de fala: aplicação em portadores de perda auditiva induzida por ruído.

BACKGROUND: Speech intelligibility. AIM: To evaluate speech recognition in individuals with noise induced hearing loss (NIHL). METHOD: 79 adults were divided in two groups: a control group with 39 individuals with hearing limits up to 25 dB, and a research group with 40 individuals with audiometric configuration and occupational history suggesting NIHL. The following tests were used with all individuals: Speech Recognition Test, dichotic test Staggered Spondaic Word (SSW) and Speech in Noise Test (signal/noise ratio of +5 and -5 dB with ipsilateral white noise). RESULTS: The Speech Recognition Test and the SSW are not or little useful to discriminate between individuals with NIHL and those with normal hearing. CONCLUSION: The Speech in Noise Test can be sensitive in the identification of the hearing alterations presented by individuals with NIHL.