RESUMO Objetivo Avaliar a atitude frente ao paciente alcoolista e o conhecimento sobre uso do álcool do estudante de Medicina em função do seu padrão de beber. Métodos Estudo transversal realizado com estudantes matriculados no terceiro, sexto e décimo primeiro período dos cursos de Medicina de três universidades federais da Região Sudeste do Brasil (UFF, UFJF e Unifesp). Foram coletados dados sociodemográficos e aplicadas escalas de avaliação da atitude médica diante do paciente alcoolista. Os dados foram complementados por uma avaliação do conteúdo científico sobre alcoolismo e pelo Audit para avaliar o padrão de ingestão de álcool dos alunos. Resultados Participaram do estudo 371 estudantes. Os consumidores de bebidas alcoólicas no padrão binge representaram 60,4% (n = 223), e 113 estudantes (30,7%) apresentaram comportamento de risco para o consumo de álcool (Audit ≥ 8). O padrão de consumo alcoólico não diferiu entre as universidades e nem entre os períodos avaliados (Kruskal Wallis, p > 0,05). Os alunos das três universidades aumentaram a pontuação na escala de conhecimentos com o progredir do curso. Entretanto, não houve correlação significativa entre conhecimento e padrão de beber (Spearman > 0,05). Quanto à atitude, foi observado que já é satisfatória no terceiro período e melhora no sexto período. Exceção foi observada entre os alunos da Unifesp, que já apresentaram atitude positiva quase máxima no terceiro período e que foi mantida até o final do curso. Conclusão Embora a atitude dos alunos melhore ao longo do curso, assim como seu conhecimento sobre adição a substâncias, o comportamento de beber permanece o mesmo, sem correlação com os conhecimentos transmitidos a respeito dos riscos de beber.

ABSTRACT Objective To evaluate the attitude toward the alcoholic patient and the knowledge about the use of alcohol by the medical student according to his drinking pattern. Method It was a cross-sectional study involving at random selected students enrolled on the third, sixth and eleventh semester in three federal universities of southeastern Brazil (UFF, UFJF and Unifesp). Method Sociodemographic data were collected and the following instruments were applied: attitude evaluation scale, knowledge of scientific information scale on alcohol and management of the alcoholic patient and Audit for evaluation of alcohol problems. Results The study included 371 students. Alcohol users in the binge pattern accounted for 60.4% (n = 223) and 113 students (30.7%) presented a risk behavior for alcohol consumption (Audit ≥ 8). The alcohol consumption pattern did not differ between the universities nor between the evaluated periods (Kruskal Wallis, p > 0.05). Students from the three universities increased the score on the knowledge scale as the course progressed. However, there was no significant correlation between knowledge and drinking pattern (Spearman > 0.05). As for the attitude, it was observed that it is already satisfactory in the third period and improvement in the sixth period. Exception was observed among the students of Unifesp, who already presented near positive attitude in the third period that was maintained until the end of the course. Conclusion Although the university increases knowledge of risk problems of drinking this does not protect students of binge drinking. On the other hand, student’s positive attitude towards alcoholic patients improves over the course, regardless of drinking and the acquired scientific knowledge.

Resumo Fundamento: No SHIFT (Systolic Heart Failure Treatment With the If Inhibitor Ivabradine Trial, ou Estudo do Tratamento da Insuficiência Cardíaca Sistólica com o Inibidor de If Ivabradina), a redução da frequência cardíaca (FC) com ivabradina associou-se com melhor sobrevida e redução das hospitalizações em pacientes com insuficiência cardíaca (IC). Os mecanismos pelos quais a FC elevada aumenta a mortalidade não são totalmente compreendidos. Objetivo: Avaliar a relação da FC basal com atividade clínica, neuro-hormonal e simpática cardíaca em pacientes com IC crônica e FC elevada. Método: Pacientes com IC crônica em ritmo sinusal e FC≥70 apesar de tratamento adequado foram incluídos em um estudo duplo-cego, randomizado, que comparou ivabradina com piridostigmina. Este artigo refere-se a dados basais dos primeiros 16 pacientes. A FC basal (antes da randomização para um dos medicamentos) foi avaliada, e os pacientes classificados em dois grupos, com FC abaixo ou acima dos valores médios. A atividade simpática cardíaca foi avaliada por cintilografia com metaiodobenzilguanidina marcada com iodo 123. Resultados: A FC média foi 83,5±11,5 bpm (intervalo 72 a 104), e sete pacientes (43.7%) tinham FC acima da média. Esses pacientes apresentaram menor distância percorrida no teste de caminhada de 6 minutos (292,3±93 vs 465,2±97,1 m, p=0,0029), valores mais altos de N-terminal do pró-BNP (mediana 708,4 vs 76,1, p=0,035) e menor relação coração/mediastino tardia, indicando desnervação cardíaca (1,48±0,12 vs 1,74±0,09, p<0,001). Conclusão: A FC de repouso elevada em pacientes com IC em tratamento médico adequado associou-se com desnervação cardíaca, pior capacidade funcional e ativação neuro-hormonal.

Abstract Background: In the Systolic Heart Failure Treatment With the If Inhibitor Ivabradine Trial (SHIFT), heart rate (HR) reduction with ivabradine was associated with improved survival and reduced hospitalizations in patients with heart failure (HF). The mechanisms by which elevated HR increases mortality are not fully understood. Objective: To assess the relationship of baseline HR with clinical, neurohormonal and cardiac sympathetic activity in patients with chronic HF and elevated HR. Method: Patients with chronic HF who were in sinus rhythm and had resting HR>70 bpm despite optimal medical treatment were included in a randomized, double-blind study comparing ivabradine versus pyridostigmine. This report refers to the baseline data of 16 initial patients. Baseline HR (before randomization to one of the drugs) was assessed, and patients were classified into two groups, with HR below or above mean values. Cardiac sympathetic activity was assessed by 123-iodine-metaiodobenzylguanidine myocardial scintigraphy. Results: Mean HR was 83.5±11.5 bpm (range 72 to 104), and seven (43.7%) patients had HR above the mean. These patients had lower 6-min walk distance (292.3±93 vs 465.2±97.1 m, p=0.0029), higher values of N-Terminal-proBNP (median 708.4 vs 76.1, p=0.035) and lower late heart/mediastinum rate, indicating cardiac denervation (1.48±0.12 vs 1.74±0.09, p<0.001). Conclusion: Elevated resting HR in patients with HF under optimal medical treatment was associated with cardiac denervation, worse functional capacity, and neurohormonal activation.

The objective of this paper was to determine changes in the prevalence of over-weight/obesity, dietary habits and physical activity at the beginning and end of the freshman year after an intervention to promote healthy habits. Anthropometric measurements and a questionnaire about healthy eating habits and exercise were applied at the start and end of the freshman year to 304 volunteers ages 14-17. Intervention consisted of lectures, sports classes and social networks such as Facebook and Twitter. There was a significant increase in the intake of portions/day of fruits and vegetables, and a reduction in days/week of sweetened beverages and chips. There was no change in the prevalence of over-weight/obesity. The massive intervention through lectures, classes and social networks improved dietary habits but did not change the prevalence of overweight/obesity. Other strategies should be tested.

El objetivo del trabajo fue determinar cambios en la prevalencia de sobrepeso/obesidad, hábitos alimenticios y ejercicio físico al inicio y final del primer año de preparatoria posterior a una intervención para promover hábitos saludables. Se realizó antropometría y cuestionario sobre alimentación y ejercicio físico al inicio y final del año escolar a 304 alumnos de catorce a diecisiete años. Se implementó un programa anual de conferencias, superclases deportivas y redes sociales como Facebook y Twitter. Se logró incrementar el consumo de raciones/día de frutas y verduras y reducir la ingestión en días/semana de refrescos y papas fritas. No hubo cambios significativos en la prevalencia de sobrepeso/obesidad. La intervención colectiva a través de clases y redes sociales mejoró los hábitos alimenticios pero no logró disminuir el sobrepeso/obesidad. Se requiere probar otro tipo de estrategia en adolescentes.

Introduction: the relationship between HIV/AIDS and mental illness has been reported, but no studies have been conducted in Cuba about psychic alterations in patients at clinical onset of AIDS. Methods: study population: patients of both sexes with a diagnosis of AIDS onset within a year after diagnosis. The record system SIDATRAT was used to list and locate the cases. The purpose was to learn about the behavior of psychic variables in patients at clinical onset of AIDS and their association with immunocompetence. Results: estimation was made of affective states, psychic self-regulation, behavioral response to the disease, CD4+ lymphocytes and viral load in 42 patients at clinical onset of AIDS with and without psychopathological symptoms. Descriptive statistics analysis, ANOVA mean comparison, was performed to relate variables and robust confirmatory tests. Negative affective states were not good indicators of psychic alteration, with homogeneous means between the groups. "Reflexive decision making responsibility" predominated among symptomatic patients, with upper means for "discontrol" and lower means for "self-control", indicative of worst coping. High "self-control" scores were associated with a low viral load, but not with TL CD4+ counts. No psychic variable was related to immunocompetence.

Introducción: se reporta la relación entre VIH/sida y enfermedad mental, pero en Cuba no se han estudiado alteraciones de la vida psíquica en pacientes con comienzo de sida. Métodos: población de estudio: pacientes con diagnóstico de aparición de sida a menos de un año del diagnóstico, de ambos sexos; se empleó el sistema de registro SIDATRAT listándose y localizándose los casos. Se propuso conocer el comportamiento de variables de la vida psíquica en pacientes con aparición de sida y su asociación con inmunocompetencia. Resultados: se estimaron estados afectivos, autorregulación psíquica, conductas frente a la enfermedad, linfocitos CD4+ y carga viral en 42 pacientes con inicio de sida con y sin síntomas psicopatológicos. Se emplearon estadísticas descriptivas y ANOVA de comparación de medias para relacionar variables y pruebas robustas confirmatorias. Los estados afectivos negativos no fueron buenos indicadores de alteración psíquica, con medias homogéneas entre grupos. En pacientes sintomáticos predominó la "toma de decisiones reflexivas-responsabilidad", con medias superiores para "descontrol" e inferiores en "autocontrol" indicadoras de peor afrontamiento. Puntajes altos para "autocontrol" se asociaron con baja carga viral, pero no con conteos de LT CD4+; no se relacionaron variables psíquicas con inmunocompetencia.