Efetividade do Toque Terapêutico sobre a dor, depressão e sono em pacientes com dor crônica: ensaio clínico

Este estudo teve como objetivo verificar a efetividade do Toque Terapêutico na diminuição da intensidade da dor, escores de auto-avaliação de depressão e melhora da qualidade do sono. Consiste em um ensaio clínico do tipo antes e depois, realizado com 30 idosos com dor crônica não-oncológica que receberam 8 sessões de Toque Terapêutico Método Krieger-Kunz na Unidade Básica de Saúde de Fernandópolis (SP), Brasil. A Escala Analógica Visual para dor foi aplicada antes e após cada sessão, o Inventário de Depressão de Beck e o Índice de Qualidade do Sono de Pittsburgh, antes da primeira e após a última. A análise dos dados demonstrou diminuição significativa (p<0,05) na intensidade da dor, dos escores de auto-avaliação de depressão e do índice de qualidade do sono. Conclui-se que o Toque Terapêutico foi efetivo na diminuição da intensidade da dor, nas atitudes e nos sintomas depressivos e na melhora da qualidade do sono.

Le début de Cartouche : comédie-vaudeville en deux actes / [par M. T. Sauvage]

Collection : La Mosaïque ; 31

Shorter time to diagnosis and improved stage at presentation in Swiss patients with retinoblastoma treated from 1963 to 2004.

OBJECTIVES: Retinoblastoma is the most frequent intraocular malignancy in children. Early diagnosis is essential for globe salvage and patient survival. The aim of our study was to determine how time to diagnosis of retinoblastoma has evolved over a 40-year period in Switzerland. METHOD AND PATIENTS: A retrospective study of 139 Swiss patients with retinoblastoma was performed comparing 3 periods: (1) 1963-1983; (2) 1984-1993; and (3) 1994-2004. Factors taken into account were gender, laterality of retinoblastoma, age at first symptoms, type and first observer of symptoms, time to diagnosis, age at diagnosis, disease stage, and family history. RESULTS: Thirty-seven patients (26.6%) were treated in period 1, 44 (31.7%) in period 2, and 58 (41.7%) in period 3. Overall, the diagnostic interval decreased in a significant way from 6.97 months in period 1 to 3.58 in period 2 and to 2.25 in period 3. When looking separately at unilateral and bilateral disease, the decrease of the diagnostic interval remained statistically significant in unilateral retinoblastoma; there was also a significant reduction in the number of patients with advanced group E disease (Murphree classification) (61.5% in period 1, 46.7% in period 2, 22.2% in period 3). In bilateral disease, the same observations were made to a lesser extent. However, there were no cases with group E disease in 10 patients with positive family history. Leukocoria (48.2%) and strabismus (20.1%) were the 2 most frequent symptoms throughout the 3 periods. The only factors that statistically influenced the chances of having a diagnosis of group E disease were the diagnostic interval and period of diagnosis. CONCLUSIONS: Progress has been made in the diagnosis of retinoblastoma in Switzerland, notably in unilateral disease. Improvement to a lesser extent has also been observed in bilateral cases but without statistical significance. Greater effort is needed to teach physicians-in-training to recognize the importance of ocular symptoms and refer patients earlier.

Benoît, ou Les deux cousins : drame en 3 actes / par M. Hippolyte Auger

Collection : La mosaïque ; N°33

Agentes Comunitários de Saúde e as vivências de prazer - sofrimento no trabalho: estudo qualitativo

Este estudo objetivou identificar as situações geradoras de prazer - sofrimento no trabalho dos Agentes Comunitários de Saúde (ACS) de um município do Rio Grande do Sul/Brasil. Foi realizada uma pesquisa de abordagem qualitativa, com participação de 24 agentes. A coleta dos dados ocorreu em 2009, por meio do grupo focal, empregando-se a técnica da análise temática. As situações geradoras de prazer no trabalho foram: ser reconhecido, ser resolutivo, trabalhar junto aos pares e usar a criatividade. As situações geradoras de sofrimento foram: deficiências nos serviços de saúde; desconhecimento das funções; falta de reconhecimento; o sofrimento de trabalhar em equipe; a obrigatoriedade de morar e trabalhar no mesmo local; convivência e envolvimento com os problemas sociais da comunidade e a exposição à violência, resultando em medo. Evidenciou-se a necessidade de adoção de medidas interventivas com vistas a promover melhores condições de trabalho, satisfação profissional e saúde aos agentes comunitários.

Incapacidade relacionada à dor lombar crônica: prevalência e fatores associados

A incapacidade relacionada à dor lombar crônica (DLC) é um fenômeno complexo e multifatorial. O objetivo desse estudo foi identificar a prevalência e os fatores associados à incapacidade em pacientes com dor lombar crônica. Estudo transversal com amostra composta por 177 pacientes com DLC, de três serviços de saúde; que responderam ao formulário com dados demográficos, ao Inventário de Depressão de Beck, às Escalas Oswestry Disability Index, de autoeficácia para dor crônica, Tampa de Cinesiofobia e de Fadiga de Piper. A prevalência de incapacidade foi de 65% (IC95%: 57,5 - 72,0) e era de moderada a grave em 80,7% dos pacientes. O modelo de regressão múltipla identificou três fatores independentemente associados à incapacidade: ausência de trabalho remunerado, autoeficácia baixa e depressão. Os fatores associados à incapacidade identificados são modificáveis. Intervenções como recolocação no trabalho, tratamento para a depressão e reconceitualização da crença de autoeficácia podem ter um impacto importante na prevenção e redução de incapacidade.

Pacientes em uso de quimioterápicos: depressão e adesão ao tratamento

Este trabalho trata-se de estudo analítico, transversal, com abordagem quantitativa, que verificou a presença de depressão e a adesão ao tratamento com quimioterápicos em pacientes oncológicos atendidos na Farmácia Central de Quimioterapia de um hospital universitário. A amostra constou de 102 pacientes e a coleta dos dados foi realizada no período de outubro de 2010 a maio de 2011. Utilizou-se a entrevista estruturada, norteada por roteiro contendo dados sociodemográficos, clínicos e terapêuticos; o Teste de Morisky e o Inventário de Depressão de Beck. Os resultados revelaram que 10,8% e 1,9% dos participantes apresentaram depressão moderada e grave, respectivamente. Houve associação estatisticamente significativa entre a presença de depressão e as variáveis renda per capita, número de cirurgias e tempo de doença. Identificou-se falta de adesão ao tratamento em 48% dos participantes. Tais resultados indicam a necessidade de treinamento da equipe de saúde para detectar transtornos depressivos e falta de adesão ao tratamento com quimioterápicos entre pacientes oncológicos.

Financial Development, Financial Fragility, and Growth

This paper studies the apparent contradiction between two strands of the literature on the effects of financial intermediation on economic activity. On the one hand, the empirical growth literature finds a positive effect of financial depth as measured by, for instance, private domestic credit and liquid liabilities (e.g., Levine, Loayza, and Beck 2000). On the other hand, the banking and currency crisis literature finds that monetary aggregates, such as domestic credit, are among the best predictors of crises and their related economic downturns (e.g., Kaminski and Reinhart 1999). The paper accounts for these contrasting effects based on the distinction between the short- and long-run impacts of financial intermediation. Working with a panel of cross-country and time-series observations, the paper estimates an encompassing model of short- and long-run effects using the Pooled Mean Group estimator developed by Pesaran, Shin, and Smith (1999). The conclusion from this analysis is that a positive long-run relationship between financial intermediation and output growth co-exists with a, mostly, negative short-run relationship. The paper further develops an explanation for these contrasting effects by relating them to recent theoretical models, by linking the estimated short-run effects to measures of financial fragility (namely, banking crises and financial volatility), and by jointly analyzing the effects of financial depth and fragility in classic panel growth regressions.

The relation of body mass index and abdominal adiposity with dyslipidemia in 27 general populations of the WHO MONICA Project.

The association between adiposity measures and dyslipidemia has seldom been assessed in a multipopulational setting. 27 populations from Europe, Australia, New Zealand and Canada (WHO MONICA project) using health surveys conducted between 1990 and 1997 in adults aged 35-64 years (n = 40,480). Dyslipidemia was defined as the total/HDL cholesterol ratio >6 (men) and >5 (women). Overall prevalence of dyslipidemia was 25% in men and 23% in women. Logistic regression showed that dyslipidemia was strongly associated with body mass index (BMI) in men and with waist circumference (WC) in women, after adjusting for region, age and smoking. Among normal-weight men and women (BMI<25 kg/m(2)), an increase in the odds for being dyslipidemic was observed between lowest and highest WC quartiles (OR = 3.6, p < 0.001). Among obese men (BMI ≥ 30), the corresponding increase was smaller (OR = 1.2, p = 0.036). A similar weakening was observed among women. Classification tree analysis was performed to assign subjects into classes of risk for dyslipidemia. BMI thresholds (25.4 and 29.2 kg/m(2)) in men and WC thresholds (81.7 and 92.6 cm) in women came out at first stages. High WC (>84.8 cm) in normal-weight men, menopause in women and regular smoking further defined subgroups at increased risk. standard categories of BMI and WC, or their combinations, do not lead to optimal risk stratification for dyslipidemia in middle-age adults. Sex-specific adaptations are necessary, in particular by taking into account abdominal obesity in normal-weight men, post-menopausal age in women and regular smoking in both sexes.

Residual antimalarials in malaria patients from Tanzania--implications on drug efficacy assessment and spread of parasite resistance.

Repeated antimalarial treatment for febrile episodes and self-treatment are common in malaria-endemic areas. The intake of antimalarials prior to participating in an in vivo study may alter treatment outcome and affect the interpretation of both efficacy and safety outcomes. We report the findings from baseline plasma sampling of malaria patients prior to inclusion into an in vivo study in Tanzania and discuss the implications of residual concentrations of antimalarials in this setting. In an in vivo study conducted in a rural area of Tanzania in 2008, baseline plasma samples from patients reporting no antimalarial intake within the last 28 days were screened for the presence of 14 antimalarials (parent drugs or metabolites) using liquid chromatography-tandem mass spectrometry. Among the 148 patients enrolled, 110 (74.3%) had at least one antimalarial in their plasma: 80 (54.1%) had lumefantrine above the lower limit of calibration (LLC = 4 ng/mL), 7 (4.7%) desbutyl-lumefantrine (4 ng/mL), 77 (52.0%) sulfadoxine (0.5 ng/mL), 15 (10.1%) pyrimethamine (0.5 ng/mL), 16 (10.8%) quinine (2.5 ng/mL) and none chloroquine (2.5 ng/mL). The proportion of patients with detectable antimalarial drug levels prior to enrollment into the study is worrying. Indeed artemether-lumefantrine was supposed to be available only at government health facilities. Although sulfadoxine-pyrimethamine is only recommended for intermittent preventive treatment in pregnancy (IPTp), it was still widely used in public and private health facilities and sold in drug shops. Self-reporting of previous drug intake is unreliable and thus screening for the presence of antimalarial drug levels should be considered in future in vivo studies to allow for accurate assessment of treatment outcome. Furthermore, persisting sub-therapeutic drug levels of antimalarials in a population could promote the spread of drug resistance. The knowledge on drug pressure in a given population is important to monitor standard treatment policy implementation.

Perdão e Esperança Na Promoção Da Saúde Mental Do Sénior

As sociedades modernas são estruturas duplamente envelhecidas, caracterizadas por uma maior longevidade dos seus membros e por uma menor taxa de natalidade, o que torna necessário a conjugação de esforços multidisciplinares para minorar as consequências desta realidade. Envelhecer com saúde, autonomia, independência, o mais tempo possível, constitui assim, hoje, um desafio à responsabilidade individual e colectiva. Com este estudo pretendeu-se conhecer de que forma é que o desenvolvimento das competências emocionais (perdão, esperança) é promotor da saúde mental do sénior. Teve como apoio uma metodologia empírica, exploratória e transversal, e como suporte análise de conteúdo e pesquisas bibliográficas. A amostra utilizada neste estudo é uma amostra de conveniência e é constituída por indivíduos residentes no Algarve (Portimão) e Alentejo (Vidigueira e Beja), composta de 82 idosos com idades compreendidas entre os 65 a 85 anos, sendo 31 do sexo masculino e 51 do sexo feminino. A recolha de informação foi efectuada através da aplicação de três instrumentos aos respectivos inqueridos: a escala sobre o Perdão (Oliveira, J.H. B., 2002); a escala de Esperança Estado (Snyder et al., 1996; Faria, M.C., 2000) – versão portuguesa; “Inventário Depressivo” (Beck, A. T., 1967), versão portuguesa de (Vaz-Serra, A. & Pio Abreu, J. L., 1973). Os resultados da aplicação dos instrumentos permitiram concluir que não houve influências do género, da idade e das habilitações académicas. Constatou-se que não existem correlações significativas entre os totais dos instrumentos. As análises efectuadas expõem valores significativos que nos permitem concluir que quanto maior é o perdão, maior é a esperança e maior é a depressão, por outro lado, quanto maior é a depressão menor é a esperança. Assim, coloca-se um desafio à Psicologia da Saúde: intervir na educação de idosos e na formação dos cuidadores dos mesmos.

Correlation between depressive symptoms and quality of life in users of psychoactive substances

Objectives: To evaluate the correlation between the presence of depressive symptoms and quality of life in users of psychoactive substances from Psychosocial Attention Centers in Mato Grosso. Method: A cross-sectional analytical study, conducted in Psychosocial Attention Centers, with 109 users. The instruments used were: Medical Outcomes Study 36, Beck Depression Inventory, socio-demographic variables and the use of psychoactive substances. A Tukey analysis and a Spearman correlation were conducted with a significance level of α<0,05. Results: The most affected domains of quality of life were emotional, social and mental health aspects, besides the strong correlation between depressive symptoms and quality of life. Conclusion: The use of psychoactive substances and the presence of symptoms significantly interfere in the life of users, which can compromise the motivation to the treatment, negatively affecting the quality of life in this population.



Modelling the effect of minor orthopaedic day surgery on patient mood at the early post-operative period: a prospective population-based cohort study.

OBJECTIVE: The effect of minor orthopaedic day surgery (MiODS) on patient's mood. METHODS: A prospective population-based cohort study of 148 consecutive patients with age above 18 and less than 65, an American Society of Anaesthesiology (ASA) score of 1, and the requirement of general anaesthesia (GA) were included. The Medical Outcomes Study - Short Form 36 (SF-36), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were used pre- and post-operatively. RESULTS: The mean physical component score of SF-36 before surgery was 45.3 (SD=+/-10.1) and 8 weeks following surgery was 44.9 (SD=+/-11.04) [n=148, p=0.51, 95% CI=(-1.03 to 1.52)]. For the measurement of the changes in mood using BDI, BAI and SF-36, latent construct modelling was employed to increase validity. The covariance between mood pre- and post-operatively (cov=69.44) corresponded to a correlation coefficient, r=0.88 indicating that patients suffering a greater number of mood symptoms before surgery continue to have a greater number of symptoms following surgery. When the latent mood constructs were permitted to have different means the model fitted well with chi(2) (df=1)=0.86 for which p=0.77, thus the null hypothesis that MiODS has no effect on patient mood was rejected. CONCLUSIONS: MiODS affects patient mood which deteriorates at 8 weeks post-operatively regardless of the pre-operative patient mood state. More importantly patients suffering a greater number of mood symptoms before MiODS continue to have a greater number of symptoms following surgery.