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Introducción. Desde inicios de la pandemia por coronavirus 2019 (COVID-19), fue comunicado en varios países un incremento de las consultas de niñas con pubertad precoz central idiopática (PPCI), sin que contáramos con datos argentinos. Este aumento estaría vinculado con los cambios en el estilo de vida y los niveles de estrés resultantes del aislamiento que afectó particularmente a la población infantil. Objetivos. 1) Describir la evolución de la incidencia de PPCI con requerimiento de inhibición del eje hipotálamo-hipófiso-gonadal (EHHG) en niñas entre 2010 y 2021 en una cohorte del Área Metropolitana de Buenos Aires. 2) Comparar las características de las niñas, con dicho diagnóstico realizado durante la pandemia, con las de un grupo control. Métodos. Serie de tiempo interrumpida y estudio de casos y controles. Resultados. La incidencia anual fue estable entre 2010 y 2017. Desde 2017 hubo un ascenso anual que promedió el 59,9 % (IC95 % 18,6-115,5) y pareciera haberse acelerado durante la pandemia. Constatamos asociación entre haber desarrollado PPCI y haber requerido tratamiento inhibitorio entre el 01 de junio de 2020 y el 31 de mayo de 2021, y dos variables: edad de menarca materna (OR 0,46; IC95 % 0,28-0,77) y antecedente familiar de PPCI (OR 4,42; IC95 % 1,16-16,86). Conclusión. Evidenciamos desde 2017 un aumento significativo en la incidencia de PPCI con requerimiento de inhibición del EHHG. El incremento en la exposición a diversos desencadenantes ambientales durante la pandemia por COVID-19 podría haber ejercido mayor influencia en las niñas con alguna predisposición genética.

Introduction. Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, consultations of girls with idiopathic central precocious puberty (ICPP) increased in several countries, but there were no data from Argentina. This increase may be related to changes in lifestyle and stress levels resulting from the lockdown, which particularly affected the child population. Objectives. 1) To describe the progression of the incidence of ICPP requiring inhibition of the hypothalamic- pituitary-gonadal (HPG) axis in girls between 2010 and 2021 in a cohort from the Metropolitan Area of Buenos Aires. 2) To compare the characteristics of girls diagnosed with ICPP during the pandemic with those of a control group. Methods. Interrupted time-series and case-control study. Results. The annual incidence remained stable between 2010 and 2017. Since 2017, it increased to an average of 59.9% (95% CI: 18.6­115.5) and appears to have accelerated during the pandemic. We found an association between ICPP and requiring inhibitory treatment between June 1 st, 2020 andMay 31 st, 2021 and 2 variables: maternal age at menarche (OR: 0.46, 95% CI: 0.28­0.77) and family history of ICPP (OR: 4.42, 95% CI: 1.16­16.86). Conclusion. We evidenced a significant increase in the incidence of ICPP with requirement of HPG axis inhibition since 2017. Increased exposure to various environmental triggers during the COVID-19 pandemic may have had a greater influence in girls with some genetic predisposition.

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Introduction. Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, consultations of girls with idiopathic central precocious puberty (ICPP) increased in several countries, but there were no data from Argentina. This increase may be related to changes in lifestyle and stress levels resulting from the lockdown, which particularly affected the child population. Objectives. 1) To describe the progression of the incidence of ICPP requiring inhibition of the hypothalamic-pituitary-gonadal (HPG) axis in girls between 2010 and 2021 in a cohort from the Metropolitan Area of Buenos Aires. 2) To compare the characteristics of girls diagnosed with ICPP during the pandemic with those of a control group. Methods. Interrupted time-series and case-control study. Results. The annual incidence remained stable between 2010 and 2017. Since 2017, it increased to an average of 59.9% (95% CI: 18.6-115.5) and appears to have accelerated during the pandemic. We found an association between ICPP and requiring inhibitory treatment between June 1st, 2020 and May 31st, 2021 and 2 variables: maternal age at menarche (OR: 0.46, 95% CI: 0.28-0.77) and family history of ICPP (OR: 4.42, 95% CI: 1.16-16.86). Conclusion. We evidenced a significant increase in the incidence of ICPP with requirement of HPG axis inhibition since 2017. Increased exposure to various environmental triggers during the COVID-19 pandemic may have had a greater influence in girls with some genetic predisposition.

Introducción. Desde inicios de la pandemia por coronavirus 2019 (COVID-19), fue comunicado en varios países un incremento de las consultas de niñas con pubertad precoz central idiopática (PPCI), sin que contáramos con datos argentinos. Este aumento estaría vinculado con los cambios en el estilo de vida y los niveles de estrés resultantes del aislamiento que afectó particularmente a la población infantil. Objetivos. 1) Describir la evolución de la incidencia de PPCI con requerimiento de inhibición del eje hipotálamo-hipófiso-gonadal (EHHG) en niñas entre 2010 y 2021 en una cohorte del Área Metropolitana de Buenos Aires. 2) Comparar las características de las niñas, con dicho diagnóstico realizado durante la pandemia, con las de un grupo control. Métodos. Serie de tiempo interrumpida y estudio de casos y controles. Resultados. La incidencia anual fue estable entre 2010 y 2017. Desde 2017 hubo un ascenso anual que promedió el 59,9 % (IC95 % 18,6-115,5) y pareciera haberse acelerado durante la pandemia. Constatamos asociación entre haber desarrollado PPCI y haber requerido tratamiento inhibitorio entre el 01 de junio de 2020 y el 31 de mayo de 2021, y dos variables: edad de menarca materna (OR 0,46; IC95 % 0,28-0,77) y antecedente familiar de PPCI (OR 4,42; IC95 % 1,16-16,86). Conclusión. Evidenciamos desde 2017 un aumento significativo en la incidencia de PPCI con requerimiento de inhibición del EHHG. El incremento en la exposición a diversos desencadenantes ambientales durante la pandemia por COVID-19 podría haber ejercido mayor influencia en las niñas con alguna predisposición genética.

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To study the macroglia and microglia and the immune role in long-time light exposure in rat eyes, we performed glial cell characterization along the time-course of retinal degeneration induced by chronic exposure to low-intensity light. Animals were exposed to light for periods of 2, 4, 6, or 8 days, and the retinal glial response was evaluated by immunohistochemistry, western blot and real-time reverse transcription polymerase chain reaction. Retinal cells presented an increased expression of the macroglia marker GFAP, as well as increased mRNA levels of microglia markers Iba1 and CD68 after 6 days. Also, at this time-point, we found a higher number of Iba1-positive cells in the outer nuclear layer area; moreover, these cells showed the characteristic activated-microglia morphology. The expression levels of immune mediators TNF, IL-6, and chemokines CX3CR1 and CCL2 were also significantly increased after 6 days. All the events of glial activation occurred after 5-6 days of constant light exposure, when the number of photoreceptor cells has already decreased significantly. Herein, we demonstrated that glial and immune activation are secondary to neurodegeneration; in this scenario, our results suggest that photoreceptor death is an early event that occurs independently of glial-derived immune responses.

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Abstract Pediatric cardiac anesthesia is a subspecialty of cardiac and pediatric anesthesiology dedicated to the perioperative care of patients with congenital heart disease. Members of the Congenital and Education Subcommittees of the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) agreed on the necessity to develop an EACTAIC pediatric cardiac anesthesia fellowship curriculum. This manuscript represents a consensus on the composition and the design of the EACTAIC Pediatric Cardiac Anesthesia Fellowship program. This curriculum provides a basis for the training of future pediatric cardiac anesthesiologists by clearly defining the theoretical and practical requirements for fellows and host centers.

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ABSTRACT: Pediatric cardiac anesthesia is a subspecialty of cardiac and pediatric anesthesiology dedicated to the perioperative care of patients with congenital heart disease. Members of the Congenital and Education Subcommittees of the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) agreed on the necessity to develop an EACTAIC pediatric cardiac anesthesia fellowship curriculum. This manuscript represents a consensus on the composition and the design of the EACTAIC Pediatric Cardiac Anesthesia Fellowship program. This curriculum provides a basis for the training of future pediatric cardiac anesthesiologists by clearly defining the theoretical and practical requirements for fellows and host centers.

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Introducción: El subtipo luminal de cáncer de mama es sensible a la terapia antiestrógenica y muestra un mejor pronóstico que el del cáncer de mama con receptor del factor de crecimiento epidérmico humano 2 enriquecido (HER2) o triple negativo. Sin embargo, el cáncer de mama tipo luminal es heterogéneo y puede tener características clínicas agresivas. Investigamos las implicaciones clínicas y pronósticas de la baja expresión del receptor de estrógeno en un grupo de carcinomas luminales HER2 negativos. Material y método: Recolectamos los datos de un grupo de 367 cánceres de mama luminales HER2 negativo que eran receptor de estrógeno (RE) positivos y receptor de progesterona (RP) positivos o negativos y los dividimos en RE+ alto (RE) y RE+ bajo (REB). Se definió REB de acuerdo a la úl- tima actualización ASCO /CAP de las recomendaciones del testeo de de RH en cáncer de mama como aquellos con expresión entre 1 y 10%. Analizamos los datos clínico-patológicos y la supervivencia según los grupos de RE y REB. Resultados: Edad media 63,9+12.8 años. Tamaño tumoral: 1,9 +0.9 cm. Se realizó Mastectomía radical modificada en 61% de los pacientes. Tipo histológico más frecuente: Ductal Infiltrante en 89,5% de los casos. Hallazgos que concuerdan con publicaciones de otros centros. Discusión: Los tumores REB resultaron en 1,6%. No hubo diferencias estadísticas en el estadio TNM y tipo histológico. Sin embargo, el grupo REB se asoció con menor edad (47 vs 57 años), tipo luminal B, mayor grado histológico y Ki 67 alto (>30%). Si bien las diferencias en supervivencia global (SG) no fueron significativas (p=0,279), observamos que a partir de los 60 meses de seguimiento la SG fue menor en el grupo REB que en el grupo RE. Conclusiones: La baja expresión del RE se asoció peor pronóstico. Podríamos considerar la baja expresión del RE como marcador pronóstico en el subtipo luminal HER2 negativo de cáncer de mama. Debido a la baja incidencia de casos REB consideramos necesario estudios adicionales con mayor número de pacientes que podrían revelar su papel negativo en el cáncer de mama.

Introduction: The luminal subtype of breast cancer is sensitive to antiestrogenic therapy and shows a better prognosis than human epidermal grow- th factor receptor 2 (HER2) enriched or triple negative breast cancer. However, luminal type breast cancer is heterogeneous and can have aggressive clinical features. We investigated the clinical and prognostic implications of low estrogen receptor expression in a group of HER2-negative luminal carcinomas. Material and method: We collected data from a group of 367 HER2 negative luminal breast cancers that were estrogen receptor (ER) positive and progesterone receptor (PR) positive or negative and divided them into ER + high (ER) and ER + low (ERL). ERL was defined when RE expression was < 10%. We analyzed the clinical-pathological data and survival accor- ding to the ER and ERL groups. Results: ERL tumors resulted in 1.6%. There were no statistical differences in TNM stage and histological type. However, the ERL group was as- sociated with younger age (47 vs 57 years), luminal type B, higher histological grade, and high Ki 67 (> 30% ). Although the differences in overall survival (OS) were not significant (p = 0.279), we observed that after 60 months of follow-up the OS was lower in the ERL group than in the ER group. Conclusions: Low ER expression was associated with a worse prognosis. We could consider low ER expression as a prognostic marker in the HER2-ne- gative luminal subtype of breast cancer. Due to the low incidence of ERL cases, we consider necessary additional studies with a larger number of patients that could reveal its negative role in breast cancer.

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A atuação como médicos e professores no enfrentamento, por mais de um ano, da pandemia de COVID-19 em diversos cenários clínicos fez-nos constatar que vivemos tempos difíceis diante de uma doença de comportamento desconhecido e, muitas vezes, imprevisível. O objetivo do presente artigo é avaliar as medidas tomadas na nossa Instituição nestes 14 meses de pandemia, e os aprendizados recorrentes, que requerem uma reflexão ponderada para sua conveniente assimilação. As medidas tomadas em 2020 incluíram a informação objetiva e regular, da situação dos nossos cenários de prática clínica, com ênfase especial nos residências de idosos sob a nossa supervisão. Informações diárias, gráficos semanais, proporcionaram uma retrato realista da situação que estávamos vivendo. As medidas tomadas, que também visavam manter alto o moral da equipe que estava na linha de frente, propiciaram ocasião para repensar nos modelos de educação médica vigente, sugerindo novas mudanças e adaptações. Finalmente, com a chegada das vacinas em 2021, as medidas que vínhamos tomando convergiram para um esforço de vacinação massiva, principalmente nos residenciais de idosos. Esse cenário que se apresentava como crítico no início da pandemia, após a vacinação transformou-se em local de alta segurança conforme os resultados apresentados. Houve também novos aprendizados nesse mesmo local -diminuição de outras afeções, piora de níveis cognitivos- que doravante serão incorporados na nossa prática clínica.

The performance as doctors and teachers in facing, for more than a year, the pandemic of COVID-19 in several clinical settings made us realize that we live in difficult times, facing a unknown disease and, often, of unpredictable behavior. The purpose of this article is to evaluate the measures taken in our Institution in these 14 months of the pandemic, and the recurrent learning, which require thoughtful reflection for its convenient assimilation. The measures taken in 2020 included objective and regular information on the situation of our clinical practice scenarios, with special emphasis on the nursing homes for elderly under our supervision. Daily information, weekly charts, provided a realistic picture of the situation we were experiencing. The measures taken, which also aimed at maintaining the morale of the team at the forefront, provided an opportunity to rethink current medical education models, suggesting new changes and adaptations. Finally, with the arrival of vaccines in 2021, the measures we had been taking converged on a massive vaccination effort, especially in nursing homes. This particular scenario, which presented itself as critical at the beginning of the pandemic, after vaccination became a place of high security, according to the results presented. There were also new learnings in that same place - reduction of other diseases, worsening of cognitive levels - which will henceforth be incorporated into our clinical practice.

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En este artículo, los autores revisan el concepto de pubertad precoz y los factores que pueden influenciar su desarrollo, en especial en las niñas y en el contexto de las medidas de aislamiento social preventivo y obligatorio durante periodos prolongados a causa de la actual pandemia por el SARS-CoV-2. (AU)

In this article, the authors review the concept of precocious puberty and the factors that may influence its development, especially in girls and in the context of preventive and mandatory social isolation measures for prolonged periods of time due to the current SARS-CoV-2 pandemic. (AU)

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The difference in the quality of care provided in nursing home facilities in Brazil proved to be important for facing the COVID-19 pandemic.

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A atual pandemia pelo COVID-19 nos faz viver tempos difíceis e inéditos. Os esforços de todos os profissionais de saúde, cada um nas suas competências, são essenciais. Enquanto pesquisadores e cientistas se debatem procurando recursos terapêuticos eficazes, aqueles que estão na linha de frente devotam seus melhores esforços no cuidado clinico dos pacientes afetados. A cada dia que passa mostra-se imprescindível o cuidado da própria equipe de saúde. Não apenas o cuidado físico (para o qual se tomam todas as providências possíveis em cada caso) mas também da saúde mental. Um elemento da equipe de saúde desanimado, pessimista, sem perspectiva é também um fator de crise, provoca insegurança nos pacientes e nas famílias -mais ainda da que lhes chega habitualmente da mídia - e nada ajuda na equipe de saúde. Torna-se preciso levantar o moral dos que lidam diariamente com esta ameaça de proporções antes nunca vistas.

The current pandemic for COVID-19 makes us live difficult and unprecedented times. The efforts of all health professionals, each in their own competencies, are essential. While researchers and scientists struggle to find effective therapeutic resources, those on the front line devote their best efforts to the clinical care of affected patients. With each passing day, the care of the health team itself is essential. Not only physical care (for which all possible measures are taken in each case), but also mental health. A discouraged, pessimistic member of the health team, without perspective is also a factor of crisis, it causes insecurity in patients and families - even more than what usually comes to them from the media - and nothing helps the health team. It is necessary to raise the morale of those who deal daily with this threat of proportions never seen before.

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Light pollution by artificial light, might accelerate retinal diseases and circadian asynchrony. The excess of light exposure is a growing problem in societies, so studies on the consequences of long-term exposure to low levels of light are needed to determine the effects on vision. The possibility to understand the molecular mechanisms of light damage will contribute to the knowledge about visual disorders related to defects in the phototransduction. Several animal models have been used to study retinal degeneration (RD) by light; however, some important aspects remain to be established. Previously, we demonstrated that cool white treatment of 200 lux light-emitting diode (LED) induces retinal transformation with rods and cones cell death and significant changes in opsin expression in the inner nuclear layer (INL) and ganglion cell layer (GCL). Therefore, to further develop describing the molecular pathways of RD, we have examined here the oxidative stress and the fatty acid composition in rat retinas maintained at constant light. We demonstrated the existence of oxidative reactions after 5 days in outer nuclear layer (ONL), corresponding to classical photoreceptors; catalase (CAT) enzyme activity did not show significant differences in all times studied and the fatty acid study showed that docosahexaenoic acid decreased after 4 days. Remarkably, the docosahexaenoic acid diminution showed a correlation with the rise in stearic acid indicating a possible association between them. We assumed that the reduction in docosahexaenoic acid may be affected by the oxidative stress in photoreceptors outer segment which in turn affects the stearic acid composition with consequences in the membrane properties. All these miss-regulation affects the photoreceptor survival through unknown mechanisms involved. We consider that oxidative stress might be one of the pathways implicated in RD promoted by light.

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BACKGROUND: Laboratory studies suggest applying positive pressure without endotracheal suction during cuff deflation and extubation. Although some studies reported better physiological outcomes (e.g. arterial blood gases) with this technique, the safety of positive pressure extubation technique has not been well studied. The aim of this study was to determine the safety of the positive-pressure extubation technique compared with the traditional extubation technique in terms of incidence of complications. METHODS: Adult subjects who were critically ill and on invasive mechanical ventilation who met extubation criteria were included. The subjects were randomly assigned to positive-pressure extubation (n = 120) or to traditional extubation (n = 120). Sequential tests for noninferiority and, when appropriate, for superiority were performed. Positive pressure was considered noninferior if the upper limit of the CI for the absolute risk difference did not exceed a threshold of 15% in favor of the traditional group, both in per protocol and intention-to-treat analyses. A P value of <.05 was considered significant. RESULTS: A total of 236 subjects were included in the primary analysis (per protocol) (119 in the positive-pressure group and 117 in the traditional group). The incidence of overall major and minor complications, pneumonia, extubation failure, and reintubation was lower in the positive-pressure group than in the traditional group, with statistical significance for noninferiority both in the per protocol (P < .001) and intention-to-treat (P < .001) analyses. The lower incidence of major complications found in the positive-pressure group reached statistical significance for the superiority comparison, both in per protocol (P = .03) and intention-to-treat (P = .049) analyses. No statistically significant differences were found in the superiority comparison for overall complications, minor complications, pneumonia, extubation failure, and reintubation. CONCLUSIONS: Positive pressure was safe and noninferior to traditional extubation methods. Furthermore, positive pressure has shown to be superior in terms of a lower incidence of major complications. (ClinicalTrials.gov registration NCT03174509.).

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Um enfoque predominantemente biomédico atribuído ao ensino e à prática das Ciências da Saúde contribui para o processo de desumanização, que representa uma das principais queixas dos usuários dos sistemas de saúde em nosso país. Qualquer estratégia para enfrentar a questão depende da presença de profissionais de saúde bem formados de um ponto de vista técnico e humanístico. As maiores deficiências concernem à formação humanística. Este artigo constitui um recorte de um estudo cujo objetivo foi investigar a efetividade da utilização de narrativas como recurso didático na formação humanística de estudantes de Medicina e Enfermagem. Entre os temas emergentes a partir de métodos qualitativos, destacou-se o currículo oculto, que permeou todos os demais e contra o qual os estudantes poderiam ser imunizados mediante a exposição a um modelo de ensino centrado no paciente e que prioriza a reflexão ética.(AU)

A predominantly biomedical focus attributed to teaching and practice in health sciences contributes to a dehumanization process, which is one of the main complaints of Brazil's health system users. Any strategy that intends to address the issue depends on the presence of well-educated health professionals from both the technical and humanistic point of view. The greatest deficits concern humanistic education. The present article presents part of a larger study that aimed to investigate the effectiveness of using narratives as a didactic resource in humanistic teducation of medical and nursing students. Among the themes that emerged from the qualitative methods, emphasis goes to the concealed curriculum, which permeated all the other themes and against which students could be inoculated through exposure to a patient-centered teaching model that gives priority to ethical reflections.(AU)

Un enfoque predominantemente biomédico atribuido a la enseñanza y práctica de las Ciencias de la Salud contribuye al proceso de deshumanización que representa una de las principales quejas de los usuarios de los sistemas de salud de nuestro país. Cualquier estrategia para enfrentar la cuestión depende de la presencia de profesionales de salud bien formados desde un punto de vista técnico y humanístico. Las mayores deficiencias se refieren a la formación humanística. Este artículo constituye un recorte de un estudio cuyo objetivo fue investigar la efectividad de la utilización de narrativas como recurso didáctico en la formación humanística de estudiantes de Medicina y Enfermería. Entre los temas emergentes a partir de métodos cualitativos se subrayó el currículo oculto que estuvo presente en todos los demás y contra el cual los estudiantes podrían inmunizarse mediante la exposición a un modelo de enseñanza centrado en el paciente y que prioriza la reflexión ética.(AU)

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The retina is part of the central nervous system specially adapted to capture light photons and transmit this information to the brain through photosensitive retinal cells involved in visual and non-visual activities. However, excessive light exposure may accelerate genetic retinal diseases or induce photoreceptor cell (PRC) death, finally leading to retinal degeneration (RD). Light pollution (LP) caused by the characteristic use of artificial light in modern day life may accelerate degenerative diseases or promote RD and circadian desynchrony. We have developed a working model to study RD mechanisms in a low light environment using light-emitting diode (LED) sources, at constant or long exposure times under LP conditions. The mechanism of PRC death is still not fully understood. Our main goal is to study the biochemical mechanisms of RD. We have previously demonstrated that constant light (LL) exposure to white LED produces a significant reduction in the outer nuclear layer (ONL) by classical PRC death after 7 days of LL exposure. The PRCs showed TUNEL-positive labeling and a caspase-3-independent mechanism of cell death. Here, we investigate whether constant LED exposure affects the inner-retinal organization and structure, cell survival and the expression of photopigments; in particular we look into whether constant LED exposure causes the death of retinal ganglion cells (RGCs), of intrinsically photosensitive RGCs (ipRGCs), or of other inner-retinal cells. Wistar rats exposed to 200 lx of LED for 2 to 8 days (LL 2 and LL 8) were processed for histological and protein. The results show no differences in the number of nucleus or TUNEL positive RGCs nor inner structural damage in any of LL groups studied, indicating that LL exposure affects ONL but does not produce RGC death. However, the photopigments melanopsin (OPN4) and neuropsin (OPN5) expressed in the inner retina were seen to modify their localization and expression during LL exposure. Our findings suggest that constant light during several days produces retinal remodeling and ONL cell death as well as significant changes in opsin expression in the inner nuclear layer.

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RESUMO O objetivo deste estudo é compreender a percepção dos alunos do segundo ano de Medicina acerca das práticas pedagógicas relacionadas à relação médico-paciente empregadas pela disciplina de Psicologia Médica numa universidade pública em São Paulo nos anos 2013-2015. Trata-se de uma pesquisa qualitativa, baseada na análise de conteúdo temático-categorial de narrativas obtidas por meio de entrevistas semiestruturadas. Quatro categorias emergiram das narrativas: a percepção dos alunos; as repercussões emocionais; as expectativas dos discentes; e propostas para aprimorar o modelo pedagógico adotado. O role-playing mostrou-se um instrumento de experiência de sensações algumas vezes prazerosas e outras nem tanto, mas que pôde colaborar na preparação dos estudantes para sua futura relação com os pacientes. Os alunos preferiram discutir casos reais e não fictícios, se possível com a participação de médicos formados.

ABSTRACT The purpose of this study is to understand second-year medical students’ views on pedagogical practices related to the doctor-patient relationship administered under the subject of Medical Psychology at a public university in São Paulo from 2013-2015. A qualitative research project, the study focused on content analysis of narratives obtained from semi-structured interviews. Four categories emerged from the narratives: students’ perceptions; emotional repercussions; students’ expectations; and proposals for improving the pedagogical model adopted. Role-playing proved to serve as an instrument for experiencing emotions that were sometimes pleasant and sometimes unpleasant, but that could help prepare students for their future relationships with patients. Students preferred to discuss real-life instead of fictitious cases with the participation of trained doctors.

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Resumo Pesquisas demonstram que, ainda hoje, a espiritualidade representa um aspecto importante na vida humana. As conquistas do modelo biomecânico de ensino e prática da medicina não conseguiram ofuscar o papel que a espiritualidade ocupa no processo saúde-doença. Seguindo uma tendência que ocorre em escolas médicas de todo o mundo, os autores introduziram, na Universidade Federal de São Paulo, a disciplina eletiva – Espiritualidade e Medicina – dirigida a estudantes de medicina e enfermagem com o objetivo de promover o reconhecimento da dimensão espiritual do paciente e, consequentemente, um atendimento mais humanizado. Após quatro anos de curso, procedeu-se a um estudo qualitativo para determinar o perfil dos estudantes que escolheram a disciplina eletiva, sua percepção em relação ao tema espiritualidade e saúde e a importância atribuída ao curso no que concerne à sua formação pessoal, profissional e humanística. Os textos produzidos pelos alunos durante o curso constituíram a principal fonte de dados. A interpretação dos dados foi realizada por meio de um enfoque da fenomenologia hermenêutica e evidenciou os seguintes temas: busca de sentido da vida; independência entre concepções acerca de Deus e espiritualidade e a importância atribuída à disciplina; espiritualidade e humanização; e espiritualidade, cuidado de si e autoconhecimento.

Abstract Research shows that, today, spirituality is an important aspect of human life. The achievements made by the biomechanical model of teaching and practice of medicine were unable to overshadow the role that spirituality plays in the health-disease process. Following a trend occurring in medical schools throughout the world, the authors introduced at the Federal University of São Paulo the optional Spirituality and Medicine class, aimed at medical and nursing students and to promote the recognition of the spiritual dimension of the patient and, thus, afford more humane care. After four years of the course being offered, a qualitative study was carried out to determine the profile of the students who chose to take the class, their perception concerning the spirituality and health topic, and the importance attributed to the course when it comes to their personal, professional, and humanistic development. The texts produced by the students during the course were the main source of data. The data were interpreted through a hermeneutic phenomenology focus and highlighted the following issues: The search for the meaning of life; independence of views about God and spirituality and the importance given to the discipline; Spirituality and humanization, and spirituality, self-care and self-knowledge.

Resumen Encuestas demuestran que, aun hoy, la espiritualidad representa un aspecto importante en la vida humana. Las conquistas del modelo biomecánico de enseñanza y práctica de la medicina no han logrado ofuscar el papel que la espiritualidad ocupa en el proceso salud-enfermedad. Siguiendo una tendencia que se registra en las escuelas médicas de todo el mundo, los autores introdujeron, en la Universidad Federal de São Paulo, la disciplina electiva —Espiritualidad y Medicina— dirigida a estudiantes de medicina y enfermería, con el objetivo de fomentar el reconocimiento de la dimensión espiritual del paciente y, en consecuencia, una atención más humanizada. Después de cuatro años de curso, se procedió a un estudio cualitativo para determinar el perfil de los estudiantes que seleccionaron la disciplina electiva, su percepción con relación al tema espiritualidad y salud, y la importancia atribuida al curso en lo que concierne a su formación personal, profesional y humanística. Los textos producidos por los alumnos durante el curso constituyeron la principal fuente de datos. La interpretación de los datos se realizó mediante un enfoque de la fenomenología hermenéutica y puso de manifiesto los siguientes temas: búsqueda de sentido de la vida; independencia entre concepciones acerca de Dios y espiritualidad y la importancia atribuida a la disciplina; espiritualidad y humanización; y espiritualidad, cuidado de sí y autoconocimiento.

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RESUMO

Based on the life experiences of acupuncturists, the scope of this study was to examine the struggle to obtain regulation of the practice of acupuncture in Brazil. The method used was Oral Live History, the core issue being the dimension of the human experience involved in this trajectory of struggles and challenges. We conducted ten interviews, following the set of procedures demanded by the Oral History technique. The information contained in the narratives was analyzed and, taking the interpretive approach called immersion/crystallization as a benchmark, the central themes of the work were established, based on which which the discussion was developed. The results indicate the emergence of highly controversial themes involving political, corporate and cultural aspects, which constitute central elements within a historical process still under development.

Assuntos