Background According to the Latin America Association for palliative care, Brazil offers only 0.48 palliative care services per 1 million inhabitants. In 2012, no accredited physicians were working in palliative care, while only 1.1% of medical schools included palliative care education in their undergraduate curricula. As a reflection of the current scenario, little research about end-of-life care has been published so that studies addressing this subject in the Brazilian setting are crucial. Methods A cross-sectional study study conducted with students applying for the medical residency of the Federal University of São Paulo were invited to voluntarily participate in an anonymous and self-administered questionnaire survey. The latter included demographic information, attitudes, prior training in end-of-life care, prior end-of-life care experience, the 20-item Palliative Care Knowledge Test (PCKT) and a consent term. Results Of the 3086 subjects applying for residency, 2349 (76%) answered the survey, 2225 were eligible for analysis while 124 were excluded due to incomplete data. Although the majority (99,2%) thought it was important to have palliative care education in the medical curriculum, less than half of them (46,2%) reported having received no education on palliative care. The overall performance in the PCKT was poor, with a mean score of 10,79 (± 3). While philosophical questions were correctly answered (81,8% of correct answers), most participants lacked knowledge in symptom control (50,7% for pain, 57,3% for dyspnea, 52,2% for psychiatric problems and 43,4% for gastrointestinal problems). Doctors that had already concluded a prior residency program and the ones that had prior experience with terminal patients performed better in the PCKT (p < 0,001). The high-performance group (more than 50% of correct answers) had received more training in end-of-life care, showed more interest in learning more about the subject, had a better sense of preparedness, as well as a higher percentage of experience in caring for terminal patients (p < 0,001). Conclusions Our study showed that Brazilian physicians lack not only the knowledge, but also training in end-of-life medicine. Important factors to better knowledge in end-of-life care were prior training, previous contact with dying patients and prior medical residency. Corroborating the literature, for this group, training showed to be a key factor in overall in this area of knowledge. Therefore, Brazilian medical schools and residency programs should focus on improving palliative training, especially those involving contact with dying patients.

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Background: According to the Latin America Association for palliative care, Brazil offers only 0.48 palliative care services per 1 million inhabitants. In 2012, no accredited physicians were working in palliative care, while only 1.1% of medical schools included palliative care education in their undergraduate curricula. Aim: The aim of the study is to assess medical knowledge in end-of-life care, in order to identify key factors that could be useful in improving palliative care in Brazilian medical schools and residency. Design: Cross sectional study, conducted in São Paulo, Brazil. Students were invited to voluntarily participate in an anonymous and self-administered questionnaire survey. The latter included demographic information, attitudes, prior training in palliative care, prior palliative care experience and the 20-item Palliative Care Knowledge Test (PCKT). Participants: Physicians applying for the medical residency of the Federal University of São Paulo. Results: Of the 3086 subjects, 2349 (76%) answered the survey, 2225 were eligible for analysis while 124 were excluded due to incomplete data. Although the vast majority (99,2%) thought it was important to have palliative care education in the medical curriculum, less than half (46,2%) reported having received any education on palliative care. The overall performance in the PCKT was poor, with a mean score of 10,79 (± 3). While philosophical questions were correctly answered (81,8%), most participants lacked knowledge in symptom control (50,7% for pain, 57,3% for dyspnea, 52,2% for psychiatric and 43,4% for gastrointestinal problems). The high performance group (> 50% of correct answers) had received more training, showed more interest in learning, had a better sense of preparedness, as well as a higher percentage of experience in caring for terminal patients (p<0,001). Conclusions: Our study showed that Brazilian’s physicians lack not only knowledge, but also training in palliative medicine. Important factors to better knowledge in end-of-life care were prior training, previous contact with dying patients and prior medical residency. Corroborating the literature, training showed to be a key factor in overall knowledge. Therefore, medical schools and residency programs should focus on improving palliative training, especially those involving contact with dying patients.

Manutenção da independência em idosos saudáveis: fórmula para um envelhecimento bem sucedido Viver mais não significa viver melhor. Camargos MCS 1 realizou um interessante estudo na cidade de São Paulo que avaliou a expectativa de vida de homens e mulheres e os anos vividos com e sem incapacidade funcional. Ele chegou à conclusão que apesar da expectativa de vida das mulheres ser superior ao dos homens, elas apresentam maior proporção de anos vividos com incapacidade funcional.Chegar aos 90 anos, mas estar dependente funcionalmente e financeiramente dos filhos, pode gerar grande estresse para o indivíduo levando a baixa qualidade de anos vividos. Além da perda da qualidade de vida, ser dependente para atividades de vida diária, é um importante preditor de mortalidade intrahospitalar e pós alta na população idosa 2 . Leva também a aumento do número de internações, aumento no tempo de internação, e aumento no risco de institucionalização.Prevenção da dependência funcional é a palavra chave na geriatria atual. A síndrome da fragilidade (composta por diminuição da velocidade de marcha, fadiga, perda de peso, sarcopenia e perda da força de preensão palmar) é hoje nosso principal alvo 3 . Sabemos que os indivíduos aparentemente "normais" podem se revelar frágeis se testados adequadamente. A fragilidade está relacionada à perda da capacidade funcional, quedas, institucionalização e mortalidade. Nestes indivíduos, uma intervenção precoce pode evitar internações e morte. O exercício físico é a intervenção terapêutica mais eficaz na melhora da qualidade de vida e funcionalidade dos idosos. Está relacionado à melhora na mobilidade, melhora da performance nas atividades de vida diária, melhora do equilíbrio, diminuição de quedas, melhora da densidade mineral óssea e aumento na sensação de bem estar.O artigo de Tavares AC et al. 4 publicado nesta edição nos mostra como medidas fisioterápicas simples e aplicadas em população idosa saudável pode levar a manutenção da independência nestes indivíduos. O estudo contou com 88% de mulheres, porcentagem esperada já que as mulheres vivem mais que os homens e procuram mais os serviços de saúde. Este fato pode parecer irrelevante a primeira vista. Mas como descrito anteriormente, as mulheres vivem mais anos com dependência para as atividades de vida diária e, portanto, devem ser a nossa população alvo para as intervenções que visem à melhora da funcionalidade.Um fato de extrema relevância neste trabalho é que ele utilizou exercícios de fácil execução e que podem facilmente ser implementados em centros de convivência e unidades básicas de saúde. Além disso, são exercícios que podem ser executados por toda a população independente das condições sócio-econômicas e de saúde. No Brasil, sabemos que isso é fundamental principalmente para os estados do norte e nordeste que contam com menos recursos financeiros. É um estudo de prevenção, já que utilizou como amostra uma população independente e vivendo na comunidade. E por tal fato, ter atingido a meta de manutenção da independência funcional f...