Factors associated with smoking in the elderly: a health survey in São Paulo (ISA-SP)

This article reports on smoking prevalence and associated factors in the elderly, based on a population-based cross-sectional study with multi-stage sampling including 1,954 individuals 60 years or older living in four areas of S?o Paulo State, Brazil. Overall smoking prevalence was 12.2%, and higher rates were associated with male gender, age 60-69 years, not belonging to an Evangelical church, lower income, low body weight, lack of leisure-time physical activity, depression/anxiety, and hypertension. There was a high prevalence of smokers among individuals with a history of stroke, cancer, and chronic obstructive pulmonary disease. The results point to the need for effective interventions in healthcare services to promote smoking cessation among the elderly, since many are unable to stop on their own, even when they have tobacco-related illnesses. Special attention should be paid to individuals that depend on the National Health System, since smoking prevalence is higher in underprivileged socioeconomic groups.     

Four-handed, two-surgeon microsurgery in neurotology

Introduction:

Since the early 1960s, microsurgical removal has been the standard for curative treatment of vestibular schwannomas and neurotologic skull base lesions. The narrow operative corridor with only one surgeon actively operating sometimes interferes with simultaneous application of standard surgical principles such as suction, counter tension, and dissection and makes attempts at “co‐surgery” into “sequential” surgery. Surgical efficiency is often delayed by the need to change surgical instruments and reorient the surgical field.

Methods:

In this four‐handed technique, the microscope is arranged with binocular microscope heads and the surgeons facing each other at the head of the patient and operating simultaneously.

Results:

Since 2006, the authors have operated 97 lesions using the four‐handed technique. The distinct visualization advantage of the 180° binocular arrangement over use of a side arm is that both surgeons have the same stereoscopic perspective. Specific ergonomic advantages were identified for rapid debulking in large tumors, simultaneous neurologic mapping for sharp facial nerve dissection, counter traction for tumor dissection, neurologic tissue retraction/protection for safe bipolar cautery, and real‐time intraoperative consultation/collaboration.

Conclusions:

Specific technical and microscope arrangements are necessary to utilize the four‐handed technique; however, distinct advantages in tissue handling and surgical efficiency are facilitated.     

Academic guidelines for the creation of a medical school curricula in Mexico

Medical training curricula is a constantly evolving field. The objective of the present study is to analyze the changes the field has undergone. Our sources of information include demographic and health surveys, surveys carried out with students and faculty members and medical school guidelines from prestigious teaching centers. We compared medical curricula offered in Mexico as well as international trends. We analyzed context requirements, current status and future trends in biological, sociomedical and clinical disciplines; research and teaching methods; adequate academic programs. We describe the state of affairs in medical teaching in Mexico and the challenges that academic programs are currently facing. We propose a curricula with horizontal and vertical planning according to skills and competences that focus on health problems to foster scientific reasoning. Teaching strategies that are student-focused and foster significant/long-lasting learning. We suggest the need to include early clinical activities, communication skills and training in technological resources. Finally, there is a need to define a teaching profile that is consistent with training programs, to include experts in technology and modern teaching methods in order to establish permanent monitoring mechanisms, and to offer incentives to academics and administrative personnel.