The prevalence of exercise-induced bronchospasm (EIB) in asthmatic individuals has been reported to vary from 40% to 90%. There are, however, few studies addressing the effects of asthma severity on airway responsiveness to exercise. The purpose of the present study was to investigate the effects of asthma severity on EIB in children. We studied 164 children classified as having intermittent (n = 63), mild persistent (n = 30), moderate persistent (n = 40), and severe persistent asthma (n = 31) according to the Global Initiative for Asthma classification. Subjects exercised for 6 min on a cycle ergometer at 80% of their maximum heart rate, and spirometry was performed before and 5, 10, and 20 min after exercise challenge. The prevalence of EIB in children with moderate or severe persistent asthma was significantly greater than in children with intermittent asthma (p < 0.001). EIB-positive children with intermittent asthma exhibited smaller changes in FEV1 than children in the other three groups (p < 0.001). There was no significant relationship between baseline FEV1 and the decline in FEV1 after exercise. We conclude that the prevalence of EIB is greater in children with more severe asthma, and that the intensity of response to exercise is not consistently related to the clinical severity of asthma.

The response of asthmatic children to exercise has usually been evaluated by forced expiratory volume in 1 sec (FEV(1)). We reasoned that other respiratory indexes derived from the forced vital capacity maneuver such as forced expiratory flow between 25-75% of vital capacity (FEF(25-75%)) would add significant information in the evaluation of the relationship between asthma severity and response to exercise. We studied 164 children with intermittent (n = 63), mild persistent (n = 30), moderate persistent (n = 40), and severe persistent asthma (n = 31). Subjects exercised for 6 min on a cycle ergometer at 80% of their maximum heart rate, and spirometry was performed before and 5, 10, and 20 min after exercise. There was good correlation between changes in FEV(1) and FEF(25-75%) after exercise (r = 0.60, P < 0.001 for intermittent asthma and r = 0.80, P < 0.001 for severe persistent asthma). The presence of a fall in both FEV(1) (>/=10%) and in FEF(25-75%) (>/=26%) when compared to a decrease in only one of these two indexes was significantly greater in children with more severe asthma (60.0% for intermittent asthma and 94.4% for severe persistent asthma, P = 0.022). FEF(25-75%) can decrease in response to exercise without changes in FEV(1), mainly in children with mild asthma. In the evaluation of the response to exercise in children with different asthma severities, more than one maximum expiratory flow-volume parameter should be used.

We studied the ability of patients not experienced in the use of peak expiratory flow meters to assess the severity of their asthma exacerbations and compared it to the assessment of experienced clinicians. We also evaluated which data of physical examination and medical history are used by physicians to subjectively evaluate the severity of asthma attacks. Fifty-seven adult patients (15 men and 42 women, with a mean (± SD) age of 37.3 ± 14.5 years and 24.0 ± 17.9 years of asthma symptoms) with asthma exacerbations were evaluated in a University Hospital Emergency Department. Patients and physicians independently evaluated the severity of the asthma attack using a linear scale. Patient score, physician score and forced expiratory volume at the first second (FEV 1 ) were correlated with history and physical examination variables, and were also considered as dependent variables in multiple linear regression models. FEV 1 correlated significantly with the physician score (rho = 0.42, P = 0.001), but not with patient score (rho = 0.03; P = 0.77). Use of neck accessory muscles, expiratory time and wheezing intensity were the explanatory variables in the FEV 1 regression model and were also present in the physician score model. We conclude that physicians evaluate asthma exacerbation severity better than patients and that physician's scoring of asthma severity correlated significantly with objective measures of airway obstruction (FEV 1 ). Some variables (the use of neck accessory muscles, expiratory time and wheezing intensity) persisted as explanatory variables in physician score and FEV 1 regression models, and should be emphasized in medical schools and emergency settings.

Background: Type 2 diabetes mellitus (T2DM) is a highly prevalent public health problem. Although there is strong evidence supporting the essential role of physical activity in the management of T2DM, the prescription of physical activity has limited success in promoting changes in behavior. The purpose of the present study was to evaluate the impact of phone call support, over the course of five weeks, as an incentive to promote walking in type 2 diabetic patients with poor glycemic control. Methods: A total of 54 type 2 diabetic patients with poor glycemic control (HbA 1C Hg ≥8%) were enrolled in a randomized controlled clinical trial that was conducted at an outpatient clinic. The intervention patients received one telephone call per week for 5 weeks to encourage activity in the form of walking. Control patients did not receive phone calls. The number of steps each subject took was recorded weekly using pedometers. Results: Intervention group there was a significant increase in the number of steps per week between the first and last week compared to the control group (P<0.001). The absolute risk reduction was 75%, and it was necessary to provide phone call support for only three patients to obtain an increase in the number of the steps between the first and the last week of the study (NNT=3.0). Conclusions: Our results suggest that the telephone call, a high cost-benefit approach, may be an efficient intervention for promoting physical activity improvement in type 2 diabetic patients with poor glycemic control.

Re si dên cia mé di ca − Espe ci a li za ção − Edu ca ção mé di ca − Edu ca ção de gra du a ção em me di ci na − Ava li a ção edu ca ci o nal KEY WORDS − Edu ca ti o nal me a su re ment − Spe ci a lism − Edu ca ti on, me di cal, un der gra du a te − Intern ship and re si dency Recebido em: 12/11/2008 Aprovado em: 08/05/2009 Ra fa el Ca sa li Ri be i ro et al. 571 -585 Mé di cos re cém-for ma dos Médicos recém-formados: sólida formação geral ou sólida formação especializada? Newly graduated doctors: solid general education or solid specialized training? Ra fa el Ca sa li Ri be i ro I Cris ti na He le na Fer re i ra Fon se ca-Gu e des I Ma ria do Pa tro cí nio Te nó rio Nu nes I RESUMOObje ti vo: Inves ti gar os efe i tos da es pe ci a li za ção pre co ce -de di ca ção se le ti va a uma es pe ci a li da de mé di ca no pe río do de gra du a ção -so bre a for ma ção ge ral dos mé di cos re cém-for ma dos. Ca su ís ti ca e méto dos: Can di da tos ao pro ces so se le ti vo a Pro gra mas de Re si dên cia Mé di ca 2008 (PSPRM), for mados na FMUSP em 2007 (uni ver so = 163), des ta ca dos e agru pa dos por car re i ra pre ten di da (CP). Este es tu do foca o de sem pe nho no PSPRM e no his tó ri co es co lar. Aná li se in ter gru pos -can di da tos a de termi na da CP x de ma is can di da tos FMUSP e in tra gru pos -de sem pe nho em di fe ren tes áre as de co nhe cimen to (AC) x mé dia nas de ma is áre as. Co e fi ci en tes de cor re la ção -en tre fa ses do PSPRM e his tó ri co. P < 0,05. Re sul ta dos e con clu sões: Exis te cor re la ção en tre his tó ri co e PSPRM. De acor do com os da dos in ves ti ga dos, hou ve ten dên cia de es pe ci a li za ção pre co ce em GO (obs te trí cia e gi ne co lo gia), PQ (psiqui a tria) e PED (pe di a tria), com pre ju í zo em áre as de co nhe ci men to não di re ta men te re la ci o na das à car re i ra pre ten di da. Can di da tos à CM (clí ni ca mé di ca) apresentaram desempenho globalmente superior ao dos demais nas provas e no histórico, possivelmente devido ao interesse mais abrangente por toda a Medicina, que levaria a uma formação mais ampla e sólida. ABSTRACTObjec ti ve: To in ves ti ga te the ef fects of early spe ci a li za ti on (de fi ned here as con cen tra ted de di ca tion to a sin gle spe ci alty du ring un der gra du a te me di cal scho ol) on the ge ne ral skills of newly gra du ated doc tors. Sam ple and Met hods: Appli cants for Admis si on to Me di cal Re si dency Pro grams at the Uni ver sity of São Pa u lo who had re cently fi nis hed the un der gra du a te me di cal cour se at the same insti tu ti on (n=163), grou ped by spe ci alty of cho i ce. The study fo cu sed on ap pli cants' per for man ce in admis si ons exams and the ir un der gra du a te gra de po int ave ra ge. Inter group analy sis -Appli cants for a spe ci fic ca re er ver sus ot her ap pli cants. Intra-group analy sis -Per for man ce in each res pec ti ve fi eld of know led ge ver sus mean per for man ce in the ot her are as stu di ed. Cor re la ti on co ef fi ci ents -bet we en each ad mis si ons...