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BACKGROUND: We present the first results of the Accreditation System of Medical Schools (Sistema de Acreditação de Escolas Médicas - SAEME) in Brazil. METHODS: We evaluated the results of the accreditation of medical schools from 2015 to 2023. The self-evaluation form of the SAEME is specific for medical education programs and has eighty domains, which results in final decisions that are sufficient or insufficient for each domain. We evaluated the results of the first seventy-six medical schools evaluated by the SAEME. RESULTS: Fifty-five medical schools (72.4%) were accredited, and 21 (27.6%) were not. Seventy-two (94.7%) medical schools were considered sufficient in social accountability, 93.4% in integration with the family health program, 75.0% in faculty development programs and 78.9% in environmental sustainability. There was an emphasis on SAEME in student well-being, with seventeen domains in this area, and 71.7% of these domains were sufficient. The areas with the lowest levels of sufficiency were interprofessional education, mentoring programs, student assessment and weekly distribution of educational activities. CONCLUSION: Medical schools in Brazil are strongly committed to social accountability, integration with the national health system, environmental sustainability and student well-being programs. SAEME is moving from episodic evaluations of medical schools to continuous quality improvement policies.

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INTRODUCTION: Professional identity formation (PIF) is recognized worldwide as an outcome of medical education grounded in the psychology of adult development and the literature on medical professionalism. However, instruments to assess and support PIF are scarce. The Professional Identity Essay (PIE) is an open-ended question assessment of PIF that elicits short narrative responses from learners and that can be analyzed to provide formative feedback and an overall stage of development. In this study, our aim was to translate and adapt the PIE to Brazilian Portuguese. METHODS: We followed a systematic procedure for the translation and cross-cultural adaptation of the instrument. A pilot study was conducted with medical students from the University of São Paulo. After providing individual formative feedback, we administered an online questionnaire to the Brazilian students to better understand the consequences of using the PIE. Content analyses of qualitative data were performed, we employ manifest content analysis, and the categories of analysis emerged from the participants' speeches. RESULTS: Students found the instrument's questions easy to interpret and self-reflective. It also gave students the opportunity to consider their PIF. The PIE was perceived as reliable and brought more awareness of the students' own processes in addition to a sense of capability to foster their own development. In the same way, the students emphasized the importance of being helped in this process. CONCLUSION: We found sufficient evidence of the validity of the PIE in terms of content, face validity, and consequences of use. The PIE enhances self-assurance in PIF through formative assessment and is sensitive to different cultures, making it a potential tool for educators.

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This study aims to analyze the impact of frailty, multimorbidity and disability on the survival of elderly people attended in a geriatric outpatient facility, and identify the clinical risk factors associated with death. It is a longitudinal study, with 133 elderly people initially evaluated in relation to frailty, multimorbidity (simultaneous presence of three or more chronic diseases) and disability in Daily Life Activities. The Kaplan Meier method was used to analyze survival time, and the Cox regression was used for association of the clinical factors with death. In follow-up over six years, 21.2% of the participants died, survival being lowest among those who were fragile (p < 0.05). The variables frailty (HR = 2.26; CI95%: 1.03-4.93) and Chronic Renal Insufficiency (HR = 3.00; CI95%: 1.20-7.47) were the factors of highest risk for death in the multivariate analysis. Frailty had a negative effect on the survival of these patients, but no statistically significant association was found in relation to multimorbidity or disability. Tracking of vulnerabilities in the outpatient geriatric service is important, due to the significant number of elderly people with geriatric syndromes that use this type of service, and the taking of decisions on directions for care of these individuals.

O objetivo deste estudo foi analisar o impacto da fragilidade, da multimorbidade e da incapacidade funcional na sobrevida de idosos assistidos em ambulatório de geriatria e identificar os fatores clínicos de risco associados ao óbito. Estudo longitudinal, com 133 idosos avaliados inicialmente em relação à fragilidade, multimorbidade (presença simultânea de 3 doenças crônicas ou mais) e perda funcional nas Atividades de Vida Diária. Utilizou-se o método Kaplan Meier, para a análise de sobrevida, e a regressão de Cox, para a associação dos fatores clínicos com o óbito. Após seguimento de seis anos, 21,2% dos participantes faleceram, sendo a sobrevida menor entre os idosos frágeis (p < 0,05). As variáveis fragilidade (HR = 2,26; IC95%: 1,03-4,93) e Insuficiência Renal Crônica (HR = 3,00; IC95%: 1,20-7,47) foram fatores de maiores riscos para óbito na análise multivariada. A fragilidade impactou negativamente na sobrevida desses pacientes, porém não foi observada associação estatisticamente significativa em relação à multimorbidade e perda funcional. O rastreio de vulnerabilidades no serviço ambulatorial de geriatria é relevante, em virtude do número expressivo de idosos portadores de síndromes geriátricas que utilizam este tipo de atendimento e do direcionamento dos cuidados desses indivíduos.

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Resumo O objetivo deste estudo foi analisar o impacto da fragilidade, da multimorbidade e da incapacidade funcional na sobrevida de idosos assistidos em ambulatório de geriatria e identificar os fatores clínicos de risco associados ao óbito. Estudo longitudinal, com 133 idosos avaliados inicialmente em relação à fragilidade, multimorbidade (presença simultânea de 3 doenças crônicas ou mais) e perda funcional nas Atividades de Vida Diária. Utilizou-se o método Kaplan Meier, para a análise de sobrevida, e a regressão de Cox, para a associação dos fatores clínicos com o óbito. Após seguimento de seis anos, 21,2% dos participantes faleceram, sendo a sobrevida menor entre os idosos frágeis (p < 0,05). As variáveis fragilidade (HR = 2,26; IC95%: 1,03-4,93) e Insuficiência Renal Crônica (HR = 3,00; IC95%: 1,20-7,47) foram fatores de maiores riscos para óbito na análise multivariada. A fragilidade impactou negativamente na sobrevida desses pacientes, porém não foi observada associação estatisticamente significativa em relação à multimorbidade e perda funcional. O rastreio de vulnerabilidades no serviço ambulatorial de geriatria é relevante, em virtude do número expressivo de idosos portadores de síndromes geriátricas que utilizam este tipo de atendimento e do direcionamento dos cuidados desses indivíduos.

Abstract This study aims to analyze the impact of frailty, multimorbidity and disability on the survival of elderly people attended in a geriatric outpatient facility, and identify the clinical risk factors associated with death. It is a longitudinal study, with 133 elderly people initially evaluated in relation to frailty, multimorbidity (simultaneous presence of three or more chronic diseases) and disability in Daily Life Activities. The Kaplan Meier method was used to analyze survival time, and the Cox regression was used for association of the clinical factors with death. In follow-up over six years, 21.2% of the participants died, survival being lowest among those who were fragile (p < 0.05). The variables frailty (HR = 2.26; CI95%: 1.03-4.93) and Chronic Renal Insufficiency (HR = 3.00; CI95%: 1.20-7.47) were the factors of highest risk for death in the multivariate analysis. Frailty had a negative effect on the survival of these patients, but no statistically significant association was found in relation to multimorbidity or disability. Tracking of vulnerabilities in the outpatient geriatric service is important, due to the significant number of elderly people with geriatric syndromes that use this type of service, and the taking of decisions on directions for care of these individuals.

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Estudo conduzido com o objetivo de contribuir para o planejamento e implementação de políticas de qualificação profissional no campo da saúde. Foram analisados 14 cursos de graduação da área da saúde: biomedicina, ciências biológicas, educação física, enfermagem, farmácia, fisioterapia, fonoaudiologia, medicina, medicina veterinária, nutrição, odontologia, psicologia, serviço social e terapia ocupacional, no período de 1991 a 2008. Dados sobre número de ingressantes, taxa de ocupação de vagas, distribuição de concluintes por habitante, gênero e renda familiar foram coletados a partir dos bancos do Ministério da Educação. Para o curso de medicina, a relação foi de 40 candidatos por vaga nas instituições públicas contra 10 nas privadas. A maioria dos ingressantes era composta por mulheres. A região Sudeste concentrou 57 por cento dos concluintes, corroborando o desequilíbrio de distribuição regional das oportunidades de formação de profissionais de saúde e indicando a necessidade de políticas de incentivo à redução dessas desigualdades.

Study conducted to support the planning and implementation of public policies on human health resources. Fourteen undergraduate health courses were analyzed: biomedicine, biological sciences, physical education, nursing, pharmacy, physical therapy, speech and language therapy, medicine, veterinary medicine, nutrition, dentistry, psychology, social work and occupational therapy between 1991 and 2008. Data on number of students admitted, college admission rates, rates of graduating student by inhabitant, gender, geographic area and family income were collected from the Brazilian Ministry of Education database. For medicine undergraduate programs there were 40 applicants per place at public institutions and 10 at private ones. Most students admitted were females. The Southeast region concentrated 57 percent of graduating students. The study revealed trends that indicates opportunity inequalities in the regional distribution of health professional education, thus supporting the need for policies aimed at reducing such inequalities.

Estudio conducido con el objetivo de contribuir a la planificación e implementación de políticas de calificación profesional en el campo de la salud. Fueron analizados 14 cursos de pregrado del área de la salud: biomedicina, ciencias biológicas, educación física, enfermería, farmacia, fisioterapia, fonoaudiología, medicina, medicina veterinaria, nutrición, odontología, psicología, servicio social y terapia ocupacional, en el período de 1991 a 2008. Datos sobre número de ingresos, tasa de ocupación de vagas, distribución de concluyentes por habitante, género y renta familiar fueron colectados a partir de bancos del Ministerio de Educación de Brasil. En el curso de medicina, la relación fue de 40 candidatos por vacante en las instituciones públicas contra 10 en las privadas. La mayoría de los ingresados estaba compuesta por mujeres. La región sudeste concentró 57 por ciento de los concluyentes, corroborando el desequilibrio de la distribución regional de las oportunidades de formación de profesionales de salud e indicando la necesidad de políticas de incentivo para la reducción de tales desigualdades.

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Study conducted to support the planning and implementation of public policies on human health resources. Fourteen undergraduate health courses were analyzed: biomedicine, biological sciences, physical education, nursing, pharmacy, physical therapy, speech and language therapy, medicine, veterinary medicine, nutrition, dentistry, psychology, social work and occupational therapy between 1991 and 2008. Data on number of students admitted, college admission rates, rates of graduating student by inhabitant, gender, geographic area and family income were collected from the Brazilian Ministry of Education database. For medicine undergraduate programs there were 40 applicants per place at public institutions and 10 at private ones. Most students admitted were females. The Southeast region concentrated 57% of graduating students. The study revealed trends that indicates opportunity inequalities in the regional distribution of health professional education, thus supporting the need for policies aimed at reducing such inequalities.

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A geração de conhecimento, responsável pelo avanço biológico no campo da saúde e que foi a grande responsável pela revolução na ciência médica do século 20, não é suficiente para resolver as demandas da atenção primária e melhorar sua resolubilidade. Essa matriz gerada pelo conhecimento cartesiano precisa ser ampliada, e, assim, surge mais um desafio aos professores da área da saúde: valorizar, incentivar e aperfeiçoar a pesquisa clínica.

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A large number of experimental studies have investigated insulin signaling in rats. In these studies different anaesthetics have been used to anaesthetize rats. However, the direct effects of anaesthetics on the regulation of the early steps of insulin action are not known. In the present study, we investigated the effect of thiopental, pentobarbital and diethyl ether on the plasma glucose disappearance rate, IR, IRS-1 and IRS-2 tyrosine phosphorylation, IRSs association with PI 3-kinase, Akt and Erk phosphorylation, in liver and muscle of rats. Fasting plasma glucose levels were higher in animals anaesthetized with ether. No differences in plasma glucose disappearance rates were observed, however. Insulin-induced IR, IRS-1 and IRS-2 tyrosine phosphorylation, association of these substrates with PI 3-kinase and Akt and ERK phosphorylation were similar in the three groups of animals in both tissues. These data suggest that both thiopental and pentobarbital may be used in studies where changes in insulin signaling are being measured and where adequate general anaesthesia is required.

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A insulina estimula a autofosforilaçäo do receptor,a tivando a capacidade tirosina quinase deste, resultando em fosforilaçäo do substrato 1 do receptor de insulina. O IRS-1 fosforilado liga-se á enzima fosfatidilinositol 3-quinase (PI 3-quinase), ativando-a. Nos últimos anos, demonstrou-se que essas etapas iniciais da açäo insulínica apresentam regulaçäo tecido específica em diferentes situaçöes fisiopatológicas. tais estudos, realizados em tecido muscular, hapático e adiposo, näo foram efetuados em tecido renal. Assim o objetivo do presente trabalho foi investigar os níveis e grau de fosforilaçäo do receptor de insulina e do IRS-1, bem como a associaçäo deste com a PI 3-quinase em tecido renal.

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Apresenta-se o caso de um paciente de carcinoma basocelular com acometimento neoplásico tardio da segunda vértebra lombar, cujo diagnóstico foi de carcinoma baso-epidermóide

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