PHASE ANGLE AS A PREDICTOR OF MUSCLE MASS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE.

BACKGROUND: Malnutrition/sarcopenia is frequent in patients with inflammatory bowel diseases (IBD), and results in muscle catabolism, impacting treatment response, postoperative complications, and quality of life. OBJECTIVE: This study aims to assess whether the phase angle (PhA) is a parameter for predicting reduced muscle mass in patients with IBD. METHODS: Adult patients with IBD were included in this cross-sectional study. For the estimation of muscle mass and the calculation of the PhA, we used bioelectrical impedance analysis (BIA). Crohn's disease (CD) and ulcerative colitis (UC) activity scores were defined using the Harvey-Bradshaw index and partial Mayo score, respectively. The area under the ROC curve was calculated to identify the PhA cut-off point for reduced muscle mass. RESULTS: The sample consisted of 145 patients, with 39 (26.9%) with IBD in the active phase. There was a correlation of the PhA with skeletal muscle mass (SMM) (rs 0.35, P<0.001) and with the skeletal muscle mass index (SMI) (rs 0.427, P<0.001), and the associations remained in the most active form (moderate or severe) of IBD. The ROC curve analysis indicated that the cut-offs points of the PhA ≤5.042 for female and PhA ≤6.079 for male can be used to predict muscle mass reduction. CONCLUSION: The PhA can be considered a predictor of muscle mass reduction in IBD patients, and we can use it for screening and monitoring the evolution of malnutrition. BACKGROUND: • This study aims to assess whether the phase angle is a parameter for predicting reduced muscle mass in patients with inflammatory bowel disease. BACKGROUND: • There was a correlation of the phase angle with skeletal muscle mass and the associations remained in disease activity. BACKGROUND: • The ROC curve analysis indicated that the cut-off point of the PhA ≤5.042° for women and PhA ≤6,079° for men can be used to predict muscle mass reduction. BACKGROUND: • The phase angle can be considered a predictor of muscle mass reduction in inflammatory bowel disease.

Ângulo de fase como preditor de massa muscular em pacientes com doença inflamatória intestinal / Phase angle as a predictor of muscle mass in patients with inflammatory bowel disease

ABSTRACT Malnutrition/sarcopenia is frequent in patients with inflammatory bowel diseases (IBD), and results in muscle catabolism, impacting treatment response, postoperative complications, and quality of life. Objective: This study aims to assess whether the phase angle (PhA) is a parameter for predicting reduced muscle mass in patients with IBD. Methods: Adult patients with IBD were included in this cross-sectional study. For the estimation of muscle mass and the calculation of the PhA, we used bioelectrical impedance analysis (BIA). Crohn's disease (CD) and ulcerative colitis (UC) activity scores were defined using the Harvey-Bradshaw index and partial Mayo score, respectively. The area under the ROC curve was calculated to identify the PhA cut-off point for reduced muscle mass. Results: The sample consisted of 145 patients, with 39 (26.9%) with IBD in the active phase. There was a correlation of the PhA with skeletal muscle mass (SMM) (rs 0.35, P<0.001) and with the skeletal muscle mass index (SMI) (rs 0.427, P<0.001), and the associations remained in the most active form (moderate or severe) of IBD. The ROC curve analysis indicated that the cut-offs points of the PhA ≤5.042 for female and PhA ≤6.079 for male can be used to predict muscle mass reduction. Conclusion: The PhA can be considered a predictor of muscle mass reduction in IBD patients, and we can use it for screening and monitoring the evolution of malnutrition.

RESUMO A desnutrição/sarcopenia é frequente em pacientes com doenças inflamatórias intestinais (DII), resultando em catabolismo muscular, com impacto nas respostas aos tratamentos, complicações cirúrgicas e na qualidade de vida. Objetivo: Este estudo tem como objetivo, avaliar se o ângulo de fase (AF) é um parâmetro para a predição de redução de massa muscular em pacientes com DII. Métodos: Pacientes adultos com DII foram incluídos neste estudo transversal. A estimativa da massa muscular e o cálculo do AF foram realizados a partir do exame de bioimpedância elétrica (BIA). As atividades da doença de Crohn e retocolite ulcerativa foram definidas pelo índice Harvey-Bradshaw e escore parcial de Mayo, respectivamente. A área de curva ROC foi calculada para identificar o ponto de corte do AF para a massa muscular reduzida. Resultados: A amostra foi composta por 145 pacientes, sendo 39 (26.9%) com DII em fase ativa. Houve correlação do AF com massa muscular esquelética (MME) (rs 0.35, P<0.001) e com o índice de massa muscular esquelética (IMME) (rs 0.427, P<0.001), mantendo-se as associações na forma mais ativa (moderada ou grave) da DII. A análise da curva ROC indicou que os pontos de corte de AF ≤5.042 para mulheres e ≤6.079 para homens podem ser usados para prever a redução da massa muscular. Conclusão: O AF pode ser considerado um preditor de redução de massa muscular nos pacientes com DII e ser utilizado para triagem e acompanhamento da evolução da desnutrição.

Parental acceptance toward behavior guidance techniques for pediatric dental visits: a meta-analysis.

This study aimed to answer the following question: What is the proportion of acceptance reported by parents toward pediatric behavior guidance techniques (BGTs)? Observational studies that evaluated parental acceptance of BGTs during pediatric dental visits among parents of non-special health care need (non-SHCN) and SHCN children were included. A search of the Cochrane Library, Latin American and Caribbean Health Sciences (LILACS), MedLine/PubMed, PsycINFO, Scopus, and Web of Science databases, in addition to gray literature, was performed until October 2021. The Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies was used for quality assessment. The certainty of evidence was assessed using the Recommendation, Assessment, Development, and Evaluation (Grade). Fifty-three studies with 4868 participants were included, and 42 were retained for the random-effects proportion meta-analysis. The methodological quality varied from low to high. The agreement with the BGTs varied from 85.6% (95%CI: 77.5-92.1; p < 0.001; I 2 = 93.6%; 16 studies; n = 1399) for tell-show-do to 25.7% (95%CI: 17.8-34.4; p < 0.001; I 2 = 90.4%; 12 studies; n = 1129) for passive protective stabilization among non-SHCN children's parents; meanwhile, among the parents of SHCN children, it varied from 89.1% (95%CI: 56.1-99.7; p < 0.001; I 2 = 95.7%; 3 studies; n = 454) for tell-show-do to 29.1% (95%CI: 11.8-50.0; p = 0.001; I 2 = 84.8%; 3 studies; n = 263) for general anesthesia. The effect estimates varied greatly, as substantial heterogeneity across studies was observed, thus limiting the confidence in the results. Parents were more likely to agree with basic BGTs over advanced BGTs, with very low certainty of evidence. Dentists should discuss BGT options with parents. Protocol registration: PROSPERO CRD42018103834.

Lysosomal acid lipase deficiency in pediatric patients: a scoping review

Abstract Objective: Lysosomal acid lipase deficiency (LAL-D) is an underdiagnosed autosomal recessive disease with onset between the first years of life and adulthood. Early diagnosis is crucial for effective therapy and long-term survival. The objective of this article is to recognize warning signs among the clinical and laboratory characteristics of LAL-D in pediatric patients through a scope review. Sources: Electronic searches in the Embase, PubMed, Livivo, LILACS, Web of Science, Scopus, Google Scholar, Open Gray, and ProQuest Dissertations and Theses databases. The dataset included observational studies with clinical and laboratory characteristics of infants, children and adolescents diagnosed with lysosomal acid lipase deficiency by enzyme activity testing or analysis of mutations in the lysosomal acid lipase gene (LIPA). The reference selection process was performed in two stages. The references were selected by two authors, and the data were extracted in June 2020. Summary of the findings: The initial search returned 1593 studies, and the final selection included 108 studies from 30 countries encompassing 206 patients, including individuals with Wolman disease and cholesteryl ester storage disease (CESD). The most prevalent manifestations in both spectra of the disease were hepatomegaly, splenomegaly, anemia, dyslipidemia, and elevated transaminases. Conclusions: Vomiting, diarrhea, jaundice, and splenomegaly may be correlated, and may serve as a starting point for investigating LAL-D. Familial lymphohistiocytosis should be part of the differential diagnosis with LAL-D, and all patients undergoing upper gastrointestinal endoscopy should be submitted to intestinal biopsy.

Lysosomal acid lipase deficiency in pediatric patients: a scoping review.

OBJECTIVE: Lysosomal acid lipase deficiency (LAL-D) is an underdiagnosed autosomal recessive disease with onset between the first years of life and adulthood. Early diagnosis is crucial for effective therapy and long-term survival. The objective of this article is to recognize warning signs among the clinical and laboratory characteristics of LAL-D in pediatric patients through a scope review. SOURCES: Electronic searches in the Embase, PubMed, Livivo, LILACS, Web of Science, Scopus, Google Scholar, Open Gray, and ProQuest Dissertations and Theses databases. The dataset included observational studies with clinical and laboratory characteristics of infants, children and adolescents diagnosed with lysosomal acid lipase deficiency by enzyme activity testing or analysis of mutations in the lysosomal acid lipase gene (LIPA). The reference selection process was performed in two stages. The references were selected by two authors, and the data were extracted in June 2020. SUMMARY OF THE FINDINGS: The initial search returned 1593 studies, and the final selection included 108 studies from 30 countries encompassing 206 patients, including individuals with Wolman disease and cholesteryl ester storage disease (CESD). The most prevalent manifestations in both spectra of the disease were hepatomegaly, splenomegaly, anemia, dyslipidemia, and elevated transaminases. CONCLUSIONS: Vomiting, diarrhea, jaundice, and splenomegaly may be correlated, and may serve as a starting point for investigating LAL-D. Familial lymphohistiocytosis should be part of the differential diagnosis with LAL-D, and all patients undergoing upper gastrointestinal endoscopy should be submitted to intestinal biopsy.

Parental acceptance toward behavior guidance techniques for pediatric dental visits: a meta-analysis

Abstract This study aimed to answer the following question: What is the proportion of acceptance reported by parents toward pediatric behavior guidance techniques (BGTs)? Observational studies that evaluated parental acceptance of BGTs during pediatric dental visits among parents of non-special health care need (non-SHCN) and SHCN children were included. A search of the Cochrane Library, Latin American and Caribbean Health Sciences (LILACS), MedLine/PubMed, PsycINFO, Scopus, and Web of Science databases, in addition to gray literature, was performed until October 2021. The Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies was used for quality assessment. The certainty of evidence was assessed using the Recommendation, Assessment, Development, and Evaluation (Grade). Fifty-three studies with 4868 participants were included, and 42 were retained for the random-effects proportion meta-analysis. The methodological quality varied from low to high. The agreement with the BGTs varied from 85.6% (95%CI: 77.5-92.1; p < 0.001; I 2 = 93.6%; 16 studies; n = 1399) for tell-show-do to 25.7% (95%CI: 17.8-34.4; p < 0.001; I 2 = 90.4%; 12 studies; n = 1129) for passive protective stabilization among non-SHCN children's parents; meanwhile, among the parents of SHCN children, it varied from 89.1% (95%CI: 56.1-99.7; p < 0.001; I 2 = 95.7%; 3 studies; n = 454) for tell-show-do to 29.1% (95%CI: 11.8-50.0; p = 0.001; I 2 = 84.8%; 3 studies; n = 263) for general anesthesia. The effect estimates varied greatly, as substantial heterogeneity across studies was observed, thus limiting the confidence in the results. Parents were more likely to agree with basic BGTs over advanced BGTs, with very low certainty of evidence. Dentists should discuss BGT options with parents. Protocol registration: PROSPERO CRD42018103834.

Children's and parents' perceptions concerning surgical attire: a systematic review / Percepções de crianças e pais sobre trajes médicos: uma revisão sistemática

ABSTRACT Objective: To review the literature about children's and parent's perceptions on surgical attire. Data source: A systematic search was conducted in the databases EMBASE, Latin American and Caribbean Health Sciences (LILACS), PubMed, PsycINFO, Scopus and Web of Science. Grey literature was searched on Google Scholar, Open Grey and ProQuest Dissertations, and Theses Database. Data synthesis: A total of 2,567 papers were identified. After a two-phase selection, 15 studies were included in narrative synthesis. Children favored wearing white coats in five of the nine included studies (55.5% [95%CI 48.3-62.7]; p=1.00). With respect to parents' preferences, results of vote counting showed that in 11 of 15 included studies, they favored physicians wearing white coats (73.3% [95%CI 67.9-78.6]; p=0.11). Conclusions: Children and parents have preferred physicians to wear a white coat with a very low certainty of evidence.

RESUMO Objetivo: Revisar a literatura sobre as percepções de crianças e seus pais a respeito de trajes médicos. Fontes de dados: Buscas sistemáticas foram conduzidas nas bases de dados EMBASE, Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), PubMed, PsycINFO, Scopus e Web of Science. A literatura cinzenta foi pesquisada no Google Scholar, Open Grey e ProQuest Dissertations e Theses Database. Síntese dos dados: Foram identificadas 2.567 publicações e, após uma seleção de duas fases, foram incluídos 15 estudos na síntese qualitativa. As crianças tinham preferência pelo uso de jaleco branco em cinco dos nove estudos incluídos (55,5% [IC95% 48,3-62,7]; p=1,00). Em 11 dos 15 estudos incluídos, os pais tinham preferência pelos médicos que utilizavam jaleco (73,3% [IC95% 67,9-78,6]; p=0,11). Conclusões: Com uma qualidade baixa de evidência, crianças e pais preferem os médicos que usam jaleco branco.

Children's and parents' perceptions concerning surgical attire: a systematic review.

OBJECTIVE: To review the literature about children's and parent's perceptions on surgical attire. DATA SOURCE: A systematic search was conducted in the databases EMBASE, Latin American and Caribbean Health Sciences (LILACS), PubMed, PsycINFO, Scopus and Web of Science. Grey literature was searched on Google Scholar, Open Grey and ProQuest Dissertations, and Theses Database. DATA SYNTHESIS: A total of 2,567 papers were identified. After a two-phase selection, 15 studies were included in narrative synthesis. Children favored wearing white coats in five of the nine included studies (55.5% [95%CI 48.3-62.7]; p=1.00). With respect to parents' preferences, results of vote counting showed that in 11 of 15 included studies, they favored physicians wearing white coats (73.3% [95%CI 67.9-78.6]; p=0.11). CONCLUSIONS: Children and parents have preferred physicians to wear a white coat with a very low certainty of evidence.

Saneamento básico inadequado impacta no desenvolvimento infantil / Inadequate sanitation impacts child development

O objetivo desta pesquisa foi avaliar o desenvolvimento motor de pré-escolares, associando o impacto das condições socioambientais no desenvolvimento motor. Foram avaliadas 342 crianças entre três e quatro anos de idade (36 a 57 meses) de duas regiões distintas: 203 escolares em uma cidade do sul do Brasil e 139 em um município nordestino. O protocolo utilizado para identificar as disfunções motoras (dispraxias) nas áreas da coordenação (fina e global); propriocepção (equilíbrio e esquema corporal); e percepção (organização espacial e temporal) foi a Escala de Desenvolvimento Motor ­ EDM. Os dados relacionados ao saneamento básico foram extraídos de documentos oficiais reconhecidos nacionalmente. Foram encontradas diferenças significativas no desenvolvimento das crianças entre os dois municípios. Os resultados mostram maior prevalência de transtornos motores no município do nordeste, totalizando 40 crianças (28,8%); enquanto no Sul, 26 crianças (12,8%) apresentaram déficits. Todos os dados que se referem ao saneamento básico e índices sociais, encontrados na literatura específica, foram inferiores na cidade nordestina quando comparados ao município da região sul. O presente estudo mostra que carências nas condições socioambientais podem impactar negativamente o desenvolvimento motor de pré-escolares, aumentando a prevalência das dispraxias.

The aim of this research was to assess the motor development in preschoolers, associating the impact of socio-environmental conditions in motor development. A total of 342 children between the ages of 3 and 4 years (36 to 57 months) from two distinct parts of Brazil participated in the study: 203 from a city in the south of Brazil and 139 in a northeast city. The tool used to identify motor dysfunction (dyspraxia) in motor coordination (fine and global), proprioception (balance and body scheme), and perception (spatial and temporal organization) was the Motor Development Scale - MDS. Data related to basic sanitation were extracted from official documents. Significant differences were found between children in the two cities. Results show a higher prevalence of motor dysfunction in the northeast city (total of 40 children - 28.8%), while in the south, 26 children (12.8%) had deficits. All data referring to basic sanitation and social indexes, found in the specific literature, were lower in the northeastern city when compared to the city of the southern region. The present study shows that deficiencies in social and environmental conditions can negatively impact motor development of preschoolers, increasing the prevalence of dyspraxia.

Perinatal and Hemodynamic Evaluation of Sildenafil Citrate for Preeclampsia Treatment: A Randomized Controlled Trial.

OBJECTIVE: To evaluate whether therapy with sildenafil citrate prolongs gestation in women with preeclampsia. METHODS: In a randomized double-blind, placebo-controlled trial, 100 singleton pregnancies with preeclampsia between 24 and 33 weeks of gestation were randomized to 50 mg oral sildenafil citrate every 8 hours or placebo. The primary outcome was prolongation of pregnancy from randomization to delivery. Secondary outcomes were changes in resistance indices of uterine, umbilical, and middle cerebral arteries by Doppler, fetal and maternal complications, and adverse neonatal outcomes. Power analysis estimated that to detect a difference of 5 days in pregnancy duration, 43 patients would have to be randomized to each group. RESULTS: From June 2013 to October 2015, 50 patients were randomized to each group. Pregnancy duration was on average 4 days longer (14.4 days, 95% confidence interval [CI] 12.5-16.6 days compared with 10.4 days, 95% CI 8.4-12.3 days, P=.008) and percent reduction in pulsatility indices of uterine and umbilical arteries higher (22.5% and 18.5%, compared with placebo 2.1% and 2.5%, P<.001) for patients treated with sildenafil compared with placebo. Maternal blood pressure before and 24 hours after randomization was lower with sildenafil (sildenafil: 100.3±5.6 mm Hg compared with 116.4±5.1 mm Hg, P<.05; placebo: 110.6±6.2 mm Hg compared with 114.7±6.5 mm Hg, P=.21). There was no difference in perinatal morbidity, mortality, or adverse effects between groups. CONCLUSION: Therapy with sildenafil citrate was associated with pregnancy prolongation of approximately 4 days compared with placebo in women with preeclampsia. CLINICAL TRIAL REGISTRATION: Brazilian Registry of Clinical Trials, www.ensaiosclinicos.gov.br, RBR-8qj4p5.

Dose-dependent sickness behavior, abortion and inflammation induced by systemic LPS injection in pregnant mice.

OBJECTIVE: Clinical and experimental evidences indicate that intrauterine inflammation during pregnancy is associated to brain damage. The objective of this study is to determine the effects of lipopolysaccharide in temperature, cytokine production and sickness behavior of pregnant dams. METHODS: A single i.p. injection of lipopolysaccharide (LPS) (50, 150 or 300 µg/kg) was administered on E18. Controls received isotonic saline. Body temperature was controlled before and 3 h after injections. Animals' behavior was assessed by the OF test 3 h following treatment. Animals were sacrificed for leukocyte, IL-1ß and TNF-α determination. Placental tissue and abortion were also examined. RESULTS: LPS administration elicited hypothermia. Abortion was observed in LPS 150 and 300 µg/kg. Leukocyte levels were significantly lower with LPS 300 µg/kg than in controls. LPS induced dose-dependent impairment in animals' locomotion. IL-1ß serum and amniotic fluid were higher than the saline, and TNF-α serum and amniotic fluid increased when compared to controls. Placental histopathologic abnormality was not found. CONCLUSION: LPS induces dose-dependent sickness behavior and hypothermia in pregnant mice. Our findings suggest that the presence of inflammation may be a causative factor for premature labor and that Escherichia coli antigens modify the concentration of pro-inflammatory agents in circulatory system and intra-uterine environment.

Incidence of congenital syphilis in the South Region of Brazil.

INTRODUCTION: The aim of this study was to establish the incidence rates of congenital syphilis in the South Region of Brazil from 2001 to 2009. METHODS: Temporal ecological and descriptive study based on the cases recorded by the System of Information of Notifiable Diseases. RESULTS: The incidence of congenital syphilis has been increasing in the South Region of Brazil since 2004; the highest incidence rates were in women who received prenatal care (113.5 new cases per 100,000 births, p<0.001), who were diagnosed with syphilis at pregnancy (69.8 new cases per 100,000 births, p=0.001), and whose partner did not undergo treatment for syphilis (53.1 new cases per 100,000 births, p=0.001). CONCLUSIONS: The population of the present study mostly consisted of adult black women with low educational levels who attended prenatal care, who were diagnosed with syphilis during pregnancy, and whose partners were not treated for syphilis. Based on these results, actions are recommended to reduce the incidence of this disease, which is preventable by early diagnosis and appropriate treatment. The present was merely an ecological study; therefore, further investigations are necessary to elucidate the causes of these findings.

Incidence of congenital syphilis in the South Region of Brazil

Introduction The aim of this study was to establish the incidence rates of congenital syphilis in the South Region of Brazil from 2001 to 2009. Methods Temporal ecological and descriptive study based on the cases recorded by the System of Information of Notifiable Diseases. Results The incidence of congenital syphilis has been increasing in the South Region of Brazil since 2004; the highest incidence rates were in women who received prenatal care (113.5 new cases per 100,000 births, p<0.001), who were diagnosed with syphilis at pregnancy (69.8 new cases per 100,000 births, p=0.001), and whose partner did not undergo treatment for syphilis (53.1 new cases per 100,000 births, p=0.001). Conclusions The population of the present study mostly consisted of adult black women with low educational levels who attended prenatal care, who were diagnosed with syphilis during pregnancy, and whose partners were not treated for syphilis. Based on these results, actions are recommended to reduce the incidence of this disease, which is preventable by early diagnosis and appropriate treatment. The present was merely an ecological study; therefore, further investigations are necessary to elucidate the causes of these findings. .

Benefícios do leite materno e impactos do leite de vaca / Benefits of maternal milk and impacts of cow milk

O trabalho destaca a supremacia da amamentação exclusiva ao seio materno para o desenvolvimento e crescimento do lactente, em relação à alimentação com fórmulas à base de leite de vaca, ressaltando as propriedades protetoras do AME contra as doenças infecciosas e outras prevalentes nos primeiros dois anos de vida...

Mudança de atitudes dos estudantes durante o curso de medicina: um estudo de coorte / Changes in medical students' attitudes during the medical course: a cohort study

INTRODUÇÃO: Devido ao possível potencial preditivo das atitudes apresentadas pelos estudantes durante o curso de graduação em Medicina, o diagnóstico e o acompanhamento de aspectos atitudinais necessários ao exercício profissional poderiam propiciar mudanças no processo de formação da identidade profissional para efetivação de uma prática médica renovada. MÉTODO: Estudo de coorte, descritivo e quantitativo, por meio da aplicação, em dois momentos, de uma escala de atitudes (tipo Likert com alpha de Cronbach = 0,87), em que se analisam cinco aspectos (ambiência, conhecimento, crença, ética e social) segundo as Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina. Os sujeitos foram 202 estudantes de Medicina (52,85% mulheres e 47,15% homens), da primeira à oitava fase, com média de idade de 21,45 anos (Q inf: 21 e Q sup: 22,50); 91,50% provenientes da escola particular; 97,52% solteiros; de família de bom padrão de escolaridade e econômico; 91,54% da Região Sul, sendo 48,77% do próprio Estado; 86,63% não exerciam atividades extracurriculares; e 86,07% tinham como meta ingressar na residência médica após a graduação. RESULTADO: Identificados dois grupos, com provável homogeneidade de comportamento, com tendência atitudinal positiva, mais frequente no sexo feminino, demonstrando provável conflito na dimensão crença. CONCLUSÕES: Os estudantes apresentaram alguns aspectos atitudinais positivos relevantes para a prática médica, não havendo diferenças substanciais considerando-se as fases e o período estudado. Foram percebidos possíveis conflitos atitudinais quando analisados os itens de determinados aspectos, permitindo uma reflexão para possível associação com as questões educacionais e fornecendo subsídios para estudos futuros.

INTRODUCTION: During medical school, the students' values and attitudes are affected by knowledge, environment and training. Due to the possible predictive potential, __ the diagnoses and monitoring of the attitude aspects needed for the professional exercise could propitiate changes in the process of the professional identity formation for the implementation of a renewed medical practice. OBJECTIVES: To measure the attitudes and to evaluate the behavior changes during the graduation process. METHOD: A cohort study, descriptive and quantitative, in which it was utilized a questionnaire, that applied in two moments an attitude range (Miranda, 2006) analyzing five aspects: environment, knowledge, beliefs, ethics and society. The attitudes were categorized in positive, negative and conflicting. The subjects were 202 medical students (52.85% women and 47.15% men), from the first to the eighth periods, with a mean age of 21.45 years; 91.50% from private schools; 97.52% single; from good socio-cultural family standards; 91.54% from the South Region, being 48,77% from the State; 86.63% did not perform extracurricular activities; and 86.07% had as their goal to join the residency program after graduation. RESULT: Identified two groups, with a probable homogeneity of behavior, with positive attitudinal trend, more common in females, demonstrating a probable conflict in belief dimension. CONCLUSIONS: Students tended to positive attitudinal aspects___ relevant to the medical practice, and showed no substantial differences considering the phases and the periods studied. Were perceived attitudinal conflicts in certain areas, allowing for a reflection of a possible association with educational issues, and providing subsidies for future studies.

[Regional differences in knowledge, attitudes, and practice in emergency contraceptive use among health sciences university students in Brazil]. / Diferenças regionais de conhecimento, opinião e uso de contraceptivo de emergência entre universitários brasileiros de cursos da área de saúde.

The aim of this study was to evaluate regional differences in knowledge, attitudes, and practice in emergency contraception use among Brazilian university students. A sample of university students answered a semi-structured questionnaire on knowledge, attitudes, and practice related to emergency contraception and sexual behavior. Fisher's exact test and ANOVA were used for statistical analysis. Statistical significance was set at p < 0.05. Ninety-six percent (n = 588) of the students had heard of emergency contraception, and 19% (n = 111) knew all the situations in which emergency contraception is indicated, with statistical differences between regions of the country. Forty-two percent of sexually active women in the sample had already used emergency contraception; 35% (n = 207) of students equated emergency contraception with abortion; and 81% (n = 473) thought emergency contraception involves health risks. No significant difference was observed between regions of the country regarding use and attitudes towards emergency contraception. Inter-regional differences in knowledge had no impact on students' attitudes and practice in emergency contraception. National awareness-raising campaigns are needed to improve knowledge on emergency contraception.

Diferenças regionais de conhecimento, opinião e uso de contraceptivo de emergência entre universitários brasileiros de cursos da área de saúde / Regional differences in knowledge, attitudes, and practice in emergency contraceptive use among health sciences university students in Brazil

O objetivo deste estudo foi avaliar as diferenças regionais de conhecimento, opinião e uso de anticoncepção de emergência entre universitários brasileiros. Questionário semi-estruturado abordando conhecimento, opinião, experiência com anticoncepção de emergência e comportamento sexual foi aplicado a adolescentes de universidades brasileiras. Para análise estatística utilizou-se o teste exato de Fisher e ANOVA. Diferenças foram significantes quando o valor de p < 0,05. Cerca de 96 por cento (n = 588) dos estudantes já tinham ouvido falar sobre anticoncepção de emergência, 19 por cento (n = 111) conheciam as situações nas quais está indicada, com diferenças inter-regionais; 42 por cento das meninas que tinham vida sexual ativa já tinham feito uso do método; 35 por cento (n = 207) dos estudantes consideravam contracepção de emergência abortiva e 81 por cento (n = 473) achavam que traz riscos à saúde, sem diferença significativa entre as regiões nas questões relativas a uso e à opinião. As diferenças inter-regionais sobre conhecimento não impactaram no uso e na opinião dos adolescentes sobre anticoncepção de emergência. Programas nacionais devem ser conduzidos para melhorar o conhecimento sobre o método.

The aim of this study was to evaluate regional differences in knowledge, attitudes, and practice in emergency contraception use among Brazilian university students. A sample of university students answered a semi-structured questionnaire on knowledge, attitudes, and practice related to emergency contraception and sexual behavior. Fisher's exact test and ANOVA were used for statistical analysis. Statistical significance was set at p < 0.05. Ninety-six percent (n = 588) of the students had heard of emergency contraception, and 19 percent (n = 111) knew all the situations in which emergency contraception is indicated, with statistical differences between regions of the country. Forty-two percent of sexually active women in the sample had already used emergency contraception; 35 percent (n = 207) of students equated emergency contraception with abortion; and 81 percent (n = 473) thought emergency contraception involves health risks. No significant difference was observed between regions of the country regarding use and attitudes towards emergency contraception. Inter-regional differences in knowledge had no impact on students' attitudes and practice in emergency contraception. National awareness-raising campaigns are needed to improve knowledge on emergency contraception.