Qualidade de vida e desempenho ocupacional de pacientes submetidos à cirurgia de epilepsia

OBJETIVO: este estudo teve como objetivo comparar a qualidade de vida e as áreas do desempenho ocupacional de pacientes epilépticos antes e doze meses após tratamento cirúrgico. METODOLOGIA: a amostra foi composta por 30 pacientes epilépticos que frequentavam o Centro de Cirurgia de Epilepsia da Faculdade de Medicina de São José do Rio Preto - FAMERP. Todos os participantes responderam a uma entrevista semiestruturada para coleta de dados sociodemográficos, ao Questionário de Qualidade de Vida em Epilepsia - 31 (QOLIE-31) e à Medida Canadense de Desempenho Ocupacional - MCDO. RESULTADOS: dezenove pacientes(63,3%) eram do sexo feminino e onze (36,7%) do sexo masculino, com idade entre 22 e 65 anos (42,1±11,9). Os resultados obtidos com o QOLIE-31 apontaram diferenças significativas em seis dos sete domínios que compõe o questionário quando comparados o período pré e pós-cirúrgico. A comparação dos resultados da COPM mostrou aumento significativo tanto na performance quanto na satisfação dos pacientes com suas atividades de vida diária, instrumentais de vida diária e de lazer. CONCLUSÃO: o tratamento cirúrgico se mostrou eficaz na melhora da qualidade de vida e no desempenho ocupacional o que pode traduzir-se a médio e longo prazo em integração social mais adequada para os pacientes epilépticos.

Insatisfação corporal e atividade física em adolescentes da região continental de Florianópolis

A relação entre atividade física e insatisfação corporal é pouco explorada na literatura. Foi examinada a insatisfação corporal em relação com o nível de atividade física em estudantes adolescentes de escolas públicas de Florianópolis. A amostra foi de 242 estudantes, 109 meninos (14,6±2,8 anos) e 133 meninas (14,3±3 anos). Os instrumentos utilizados foram: questionário de atividades físicas habituais e escala de percepção de silhueta corporal. Quarenta e três por cento dos meninos e 29,4% das meninas são pouco ativos. Sessenta e nove por cento dos meninos e 76,7% das meninas estão insatisfeitos com sua silhueta corporal. Os meninos demonstram uma tendência em aumentar e diminuir sua silhueta, enquanto as meninas demonstram querer diminuir. Não foi encontrada relação entre satisfação com a silhueta corporal e nível de atividade física habitual. Investigar a relação entre atividade física e insatisfação corporal pode auxiliar em pesquisas futuras que verifiquem intervenções terapêuticas com atividade física no tratamento da insatisfação corporal.

Formal performance appraisal interviews: Can they really be objective, and are they useful anyway?

This paper reports on a qualitative field study conducted in Australia which examined what is occurring in formal performance appraisal interviews in relation to their objectivity and resultant outcomes. Supervisors and subordinates who had recently been involved in performance appraisals were interviewed about their experiences of the process. Perceptions of the utility of, and satisfaction with the interview process were examined. Further, the effect of the relationship between the participants on objectivity was investigated. Results indicated that formal appraisal interviews were not perceived to be of great utility, and that the relationship of the participants influenced the interview.

Women's health Australia: Recruitment for a national longitudinal cohort study

The Women's Health Australia (WHA) project is a longitudinal study of several cohorts of Australian women, which aims to examine the relationships between biological, psychological, social and lifestyle factors and women's physical health, emotional well-being, and their use of and satisfaction with health care. Using the Medicare database as a sampling frame (with oversampling of women from rural and remote areas), 106,000 women in the three age groups 18-23, 45-50 and 70-75 were sent an invitation to participate and a 24-page self-complete questionnaire. Reminder letters, a nation-wide publicity campaign, information brochures, a freecall number for inquiries, and the option of completing the questionnaire by telephone in English or in the respondent's own language, were used to encourage participation. Statutory regulations precluded telephone follow-up of non-respondents. Response rates were 41% (N = 14,792), 54% (N = 14,200) and 36% (N = 12,614) for the three age groups. Comparison with Australian census data indicated that the samples are reasonably representative of Australian women in these age groups, except fur a somewhat higher representation of women who are married or in a defacto relationship, and of women with post-school education. The most common reason for non-participation was lack of interest or time. Personal circumstances, objections to the questionnaire or specific items in it, and concerns about confidentiality were the other main reasons. Recruitment of three representative age-group cohorts of women, and the maintenance of these cohorts over a number of years, will provide a valuable opportunity to examine associations over time between aspects of women's lives and their physical and emotional health and well-being.

The effects of adolescent cannabis use on educational attainment: a review

This paper reviews research examining the link between cannabis use and educational attainment among youth. Cross-sectional studies have revealed significant associations between cannabis use and a range of measures of educational performance including lower grade point average, less satisfaction with school, negative attitudes to school, increased rates of school absenteeism and poor school performance. However, results of cross-sectional studies cannot be used to determine whether cannabis use causes poor educational performance, poor educational performance is a cause of cannabis use or whether both outcomes are a reflection of common risk factors. Nonetheless, a number of prospective longitudinal studies have indicated that early cannabis use may significantly increase risks of subsequent poor school performance and, in particular, early school leaving. This association has remained after control for a wide range of prospectively assessed covariates. Possible mechanisms underlying an association between early cannabis use and educational attainment include the possibility that cannabis use induces an 'amotivational syndrome' or that cannabis use causes cognitive impairment. However, there appears to be relatively little empirical support for these hypotheses. It is proposed that the link between early cannabis use and educational attainment arises because of the social context within which cannabis is used. In particular, early cannabis use appears to be associated with the adoption of an anti-conventional lifestyle characterized by affiliations with delinquent and substance using peers, and the precocious adoption of adult roles including early school leaving, leaving the parental home and early parenthood.

The efficacy of a universal school-based program to prevent adolescent depression

Evaluated whether a universal school-based program, designed to prevent depression in adolescents, could be effectively implemented within the constraints of the school environment. Participants were 260 Year 9 secondary school students. Students completed measures of depressive symptoms and hopelessness and were then assigned to 1 of 3 groups: (a) Resourceful Adolescent Program Adolescents (RAP A), an 11-session school-based resilience building program, as part of the school curriculum; (b) Resourceful Adolescent Program-Family (RAP-F), the same program as in RAP A, but in which each student's parents were also invited to participate in a 3-session parent program; and (c) Adolescent Watch, a comparison group in which adolescents simply completed the measures. The program was implemented with a high recruitment (88%), low attrition rate (5.8%), and satisfactory adherence to program protocol. Adolescents in either of the RAP programs reported significantly lower levels of depressive symptomatology and hopelessness at post-intervention and 10-month follow-up, compared with those in the comparison group. Adolescents also reported high satisfaction with the program. The study provides evidence for the efficacy of a school-based universal program designed to prevent depression in adolescence.

The health of Filipinas in the Hunter region

An interview survey found lifestyle behaviours (including risk factors and screening), social support and psychological health (GHQ-12) among a sample of 198 Filipina-Australians to be conducive to good health, Knowledge of local health services was good, and most women expressed general satisfaction with all aspects of life in Australia, except in the area of employment prospects. Despite these indications of good health in the group, there remains a need for health service providers to be aware of the difficulties faced by a proportion of Filipina migrants to Australia.

Child psychiatry takes to the streets: A developmental partnership between a university institute and children and adolescents from the streets of Sao Paulo, Brazil

Objective: High levels of domestic violence, mental illness, and alienation from authorities are associated with high incidence of children/adolescents living on the streets in low and middle income countries. The Equilibrium Project (Programa Equilibrio) was created to facilitate social reintegration through a virtual partnership between an academic psychiatric institute and highly vulnerable children and adolescents living on the streets, in group shelter with supervision, and in other high risk situations. Methods: Descriptive presentation of qualitative data and analysis of preliminary empirical data collected over a 24-month period. Results: Dialogue between academic professionals, street children, and city officials shaped The Equilibrium Project over the last 2 years. The program has progressively moved from a professional clinic setting to a community-based but protected activity center with recreational and professional services and an emphasis on linkage with social service agencies, city government and law enforcement officials in an academic research context. A total of 351 patients have been served of whom virtually all were neglected by their parents, 58.4% report physical or sexual abuse, 88.89% have been diagnosed with a psychiatric disorder, 40.4% drug use. After 2 years of operation, 63.5% (n = 223) successfully completed or continue in treatment and 34.8% (n = 122) were reunited with their families. Conclusions and Practice implications: Program development guided by consumer input led to a successful program offering professional services in a protected community setting that facilitates social reintegration by providing ""go between"" services integrating relationships between alienated consumers and formal psychiatric, pediatric, social service, and criminal justice systems. (C) 2011 Elsevier Ltd. All rights reserved.

An evidence-based medicine fellowship in a children's teaching hospital

This paper reports the introduction of an evidence-based medicine fellowship in a children’s teaching hospital. The results are presented of a self-reported ‘evidence-based medicine’ questionnaire, the clinical questions requested through the information retrieval service are outlined and the results of an information retrieval service user questionnaire are reported. It was confirmed that clinicians have frequent clinical questions that mostly remain unanswered. The responses to four questions with ‘good quality’ evidence-based answers were reviewed and suggest that at least one-quarter of doctors were not aware of the current best available evidence. There was a high level of satisfaction with the information retrieval service; 19% of users indicated that the information changed their clinical practice and 73% indicated that the information confirmed their clinical practice. The introduction of an evidence-based medicine fellowship is one method of disseminating the practice of evidence-based medicine in a tertiary children’s hospital.

The impact of participation in activities while on vacation on senior's psychological well-being: A path model application

This article extends earlier research regarding the relationships between senior travelers’ participation in activities while on vacation, their overall satisfaction with their travel experiences, and their psychological well-being. A path model was developed to depict the direct and indirect relationships between these variables by using a sample of senior tourists traveling on North American escorted tour itineraries. Whereas the direct effect accounted for 98% of the relationships between the senior tourists’ levels of participation in activities and their psychological well-being, the indirect effect was negligible. The study concluded that senior tourists’activity levels were significantly related to their psychological well-being, but their satisfaction with the tours was not.

Terminally ill cancer patients' wish to hasten death

This exploratory study investigated factors associated with the wish to hasten death among a sample of terminally ill cancer patients. Semi-structured interviews conducted on a total of 72 hospice and home palliative care patients were subjected to qualitative analysis using QSR-NUDIST. The main themes to emerge suggested that patients with a high wish to hasten death had greater concerns with physical symptoms and psychological suffering, perceived themselves to be more of a burden to others, and experienced higher levels of demoralization, while also reporting less confidence in symptom control, fewer social supports, less satisfaction with life experiences and fewer religious beliefs when compared with patients who had a moderate or no wish to hasten death. The implications of these findings will be discussed.

Cost comparison of hospital- and home-based treatment models for acute chronic obstructive pulmonary disease

This trial compared the cost of an integrated home-based care model with traditional inpatient care for acute chronic obstructive pulmonary disease (COPD). 25 patients with acute COPD were randomised to either home or hospital management following request for hospital admission. The acute care at home group costs per separation ($745, CI95% $595-$895, n = 13) were significantly lower (p < 0.01) than the hospital group ($2543, CI95% $1766-$3321, n = 12). There was an improvement in lung function in the hospital-managed group at the Outpatient Department review, decreased anxiety in the Emergency Department in the home-managed group and equal patient satisfaction with care delivery. Acute care at home schemes can substitute for usual hospital care for some patients without adverse effects, and potentially release resources. A funding model that allows adequate resource delivery to the community will be needed if there is a move to devolve acute care to community providers.

The suitability of written education materials for stroke survivors and their carers

This study evaluated the suitability of written materials for stroke survivors and their carers. Twenty stroke survivors and 14 carers were interviewed about the stroke information they had received and their perceptions of the content and presentation of materials of increasing reading difficulty. The mean readability level of materials (grade 9) was higher than participants’ mean reading ability (grade 7–8). Satisfaction with materials decreased as the content became more difficult to read. Seventy-five percent reported that their information needs were not met in hospital. More stroke survivors with aphasia wanted support from health professionals to read and understand written information, and identified simple language, large font size, color, and diagrams to complement the text as being important features of written materials. Simple materials that meet clients’ information needs and design preferences may optimally inform them about stroke.

Core outcome domains for chronic pain clinical trials: IMMPACT recommendations

Objective. To provide recommendations for the core outcome domains that should be considered by investigators conducting clinical trials of the efficacy and effectiveness of treatments for chronic pain. Development of a core set of outcome domains would facilitate comparison and pooling of data, encourage more complete reporting of outcomes, simplify the preparation and review of research proposals and manuscripts, and allow clinicians to make informed decisions regarding the risks and benefits of treatment. Methods. Under the auspices of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT), 27 specialists from academia. governmental agencies, and the pharmaceutical industry participated in a consensus meeting and identified core outcome domains that should be considered in clinical trials of treatments for chronic pain. Conclusions. There was a consensus that chronic pain clinical trials should assess outcomes representing six core domains: (1) pain, (2) physical functioning, (3) emotional functioning, (4) participant ratings of improvement and satisfaction with treatment, (5) symptoms and adverse events, (6) participant disposition (e.g. adherence to the treatment regimen and reasons for premature withdrawal from the trial). Although consideration should be given to the assessment of each of these domains, there may be exceptions to the general recommendation to include all of these domains in chronic pain trials. When this occurs, the rationale for not including domains should be provided. It is not the intention of these recommendations that assessment of the core domains should be considered a requirement for approval of product applications by regulatory agencies or that a treatment must demonstrate statistically significant effects for all of the relevant core domains to establish evidence of its efficacy. (C) 2003 International Association for the Study of Pain.

Clinicians' attitudes to clinical practice guidelines

To the Editor: In their systematic review of clinicians' attitudes to clinical practice guidelines, Farquhar et al1 found that, although healthcare providers reported high satisfaction with guidelines, a significant number also expressed concerns about their practicality, their role in cost-cutting and their potential for increasing litigation. The review, however, did not address other potentially significant concerns of clinicians regarding the perceived validity of guidelines and the influence of external agencies (such as the pharmaceutical industry) on treatment recommendations.