Factors associated with infant feeding practices after hospital discharge

OBJECTIVE: To assess factors associated with infant feeding practices on the first day at home after hospital discharge. METHODS: A total of 209 women, who had a child aged four months or less and were living in Itapira, Brazil, were interviewed during the National Immunization Campaign Day in 1999. Statistical analysis was performed using the Chi-square test and a logistic regression model was used for verifying an association between dependent and independent variables. RESULTS: Women aged 25.5 years on average and 18.2% were teenagers. Fifty-three percent of the women delivered vaginally and most vaginal deliveries (78.5%) took place in the public hospital. The prevalence of exclusive breastfeeding on the first day at home was 78.1% and 11.6% of the infants were receiving formula at this time. The only factor associated with EBF on the first day at home was being a teenaged-primiparous mother (OR=9.40; 95% CI: 1.24-71.27). This association remained statistically significant even after controlling for type of delivery and hospital where the birth took place. Feeding formula on the first day at home was only significantly associated with the hospital (i.e., birth at the city hospital was a protective factor (OR=0.33; 95% CI: 0.13-0.86), even after controlling for vaginal delivery. CONCLUSIONS: On the first day at home after hospital discharge, teenaged-primiparous mothers were more likely to exclusive breastfeeding as well as those infants born in the municipal public hospital. Further studies are needed from a multidisciplinary approach.

Conhecimentos sobre VIH sida nos clientes de um hospital de Lakes State, Sudão do Sul

Enquadramento: O VIH/Sida exige uma ação direcionada na vertente da prevenção, cujo suporte integra a transmissão de conhecimentos promotores da adoção e manutenção de comportamentos seguros, em conformidade com as características sociais e culturais dos indivíduos. Objetivos: Validar, para a população do Sudão do Sul, a Escala de Conhecimentos sobre VIH/Sida, The HIV Knowledge Questionnaire: HIV-KQ-45, de Carey et al. (1997); analisar de que forma as variáveis sociodemográficas influenciam os conhecimentos sobre VIH/Sida, dos cidadãos de Mapuordit Sudão do Sul; verificar se a frequência de formação sobre VIH/Sida influencia o seu nível de conhecimentos. Metodologia: Estudo quantitativo, descritivo-analítico e transversal, com 232 clientes do Mary Immaculate de Mapuordit Hospital. Foi utilizado um Questionário de caracterização sociodemográfica e do contexto de formação sobre o VIH/Sida, e o HIV Knowledge Questionnaire (HVI-K-Q) de Carey, Morrison-Beedy e Johnson (1997). Resultados: Amostra é maioritariamente masculina (74.6%), com uma média de idade 22,83 (±5.793 anos). A análise fatorial confirmatória do HIV-K-Q permitiu apurar 5 fatores, cujos valores médios mais significativos foram nos fatores preconceitos/medos (média=80.60%), conhecimentos sobre os comportamentos de risco (média=76.58%) e vias de transmissão (média=70.36%). Os sudaneses pontuaram maioritariamente com razoáveis conhecimentos sobre a Sida (média=68.08%). As mulheres, os participantes mais velhos, com companheiro(a), mais escolarizados, profissionalmente ativos, a distar do hospital =<20 Km, deslocando-se num veículo não motorizado e com diagnóstico de VIH relataram mais conhecimentos sobre a Sida. Os participantes com informação sobre a prevenção do VIH/Sida e frequência em workshop na área demonstraram melhores conhecimentos. Revelaram-se preditivas dos conhecimentos acerca da doença as habilitações literárias (β=0.32) e o diagnóstico de VIH/Sida (β=0.14) revelou-se preditor dos conhecimentos sobre os comportamentos de risco. Conclusão: As casuísticas significativas do VIH/Sida justificam considerar as habilitações literárias e a presença de diagnóstico VIH/Sida como variáveis a avaliar previamente ao planeamento estratégico das ações de educação para a prevenção do VIH/Sida no Sudão do Sul. Palavras-chave: Conhecimentos; VIH/Sida; Sudão do Sul.

Nutritional status influences generic and disease-specific quality of life measures in haemodialysis patients

Background: Poor nutritional status and worse health-related quality of life (QoL) have been reported in haemodialysis (HD) patients. The utilization of generic and disease specific QoL questionnaires in the same population may provide a better understanding of the significance of nutrition in QoL dimensions. Objective: To assess nutritional status by easy to use parameters and to evaluate the potential relationship with QoL measured by generic and disease specific questionnaires. Methods: Nutritional status was assessed by subjective global assessment adapted to renal patients (SGA), body mass index (BMI), nutritional intake and appetite. QoL was assessed by the generic EuroQoL and disease specific Kidney Disease Quality of Life-Short Form (KDQoL-SF) questionnaires. Results: The study comprised 130 patients of both genders, mean age 62.7 ± 14.7 years. The prevalence of undernutrition ranged from 3.1% by BMI ≤ 18.5 kg/m2 to 75.4% for patients below energy and protein intake recommendations. With the exception of BMI classification, undernourished patients had worse scores in nearly all QoL dimensions (EuroQoL and KDQoL-SF), a pattern which was dominantly maintained when adjusted for demographics and disease-related variables. Overweight/obese patients (BMI ≥ 25) also had worse scores in some QoL dimensions, but after adjustment the pattern was maintained only in the symptoms and problems dimension of KDQoL-SF (p = 0.011). Conclusion: Our study reveals that even in mildly undernourished HD patients, nutritional status has a significant impact in several QoL dimensions. The questionnaires used provided different, almost complementary perspectives, yet for daily practice EuroQoL is simpler. Assuring a good nutritional status, may positively influence QoL.

Performance of rubella suspect case definition: implications for surveillance

OBJECTIVE: To assess the performance of the rubella suspect case definition among patients with rash diseases seen at primary care units. METHODS: From January 1994 to December 2002, patients with acute rash, with or without fever, were seen at two large primary health care units and at a public general hospital in the municipality of Niterói, metropolitan area of Rio de Janeiro, Brazil. Data from clinical and serologic assessment were used to estimate the positive predictive values of the definition of rubella suspect case from the Brazilian Ministry of Health and other combination of signs/symptoms taking serologic status as the reference. Serum samples were tested for anti-rubella virus IgM using commercially available enzyme immunoassays. Positive predictive values and respective 95% confidence intervals were calculated. RESULTS: A total of 1,186 patients with an illness characterized by variable combinations of rash with fever, arthropathy and lymphadenopathy were studied. Patients with rash, regardless of other signs and symptoms, had 8.8% likelihood of being IgM-positive for rubella. The Brazilian suspect case definition (fever and lymphadenopathy in addition to rash) had low predictive value (13.5%). This case definition would correctly identify 42.3% of the IgM-positive cases, and misclassify 26.1% of the IgM-negative cases. CONCLUSIONS: These results support the recommendation to investigate and collect clinical specimens for laboratory diagnosis of all cases of rash, for surveillance purposes. Although this strategy may increase costs, the benefits of interrupting the circulation of rubella virus and preventing the occurrence of congenital rubella syndrome should pay off.

An empirical analysis about motivations among Hospital volunteers

Considerado como best paper desta conferência.

Hospital volunteers – are they satisfied?

We examine satisfaction with HRM practices, namely recruitment, training and rewarding in NPO’s and attitudes regarding the appropriateness of these practices. The participants in this study are 76 volunteers, affiliated to 4 different NPO’s, which work in hospitals and have direct contact with patients and their families. Analysing aggregate results we show that volunteers are more satisfied with training, and consider that the training strategies are very appropriate. After identifying differences between organisations we discover that in some organizations volunteers are satisfied with rewards, but in opposition they have negative attitudes regarding the appropriateness of the recognition strategies and vice-versa an opposite relation between satisfaction with reward and recognition strategies and the process of reward and recognition. We also name the more and less satisfied volunteers.

Motivation among Hospital volunteers: an empirical analysis in Portugal

The purpose of this paper is to identify the different types of motivations in hospital volunteers. We present a literature review about different types of motivation and we collect data from hospital volunteers through a questionnaire. Four different motivation categories are identified: development and learning, altruism, career recognition and belonging and protection. The main motivations expressed are development and learning, followed by altruism. Belonging and protection, followed by career recognition are the least cited motivations. Career recognition is negatively correlated with age, and belonging/ protection is negatively correlated with education. That is, younger volunteers present more career recognition motives and less educated volunteers have more from protection and belonging. This study encompasses hospital volunteers and their motivations. The paper is useful to policy makers aiming to develop targeted approaches to attracting and retaining volunteers.

Organisational influence on volunteer satisfaction and attitudes towards HRM practices: the case of hospital volunteers

We examine volunteer satisfaction with HRM practices, namely recruitment, training and reward in NPOs and attitudes regarding the appropriateness of these practices. The participants in this study are 76 volunteers affiliated with four different NPOs, who work in hospitals and have direct contact with patients and their families. Analysing aggregate results we show that volunteers are more satisfied with training, and consider the training strategies to be very appropriate. After identifying differences between organisations we discover that in some organisations volunteers are satisfied with rewards but they have negative attitudes regarding the appropriateness of the recognition strategies. We also identify the volunteers who are the most and the least satisfied.

Análise comparativa dos Estilos de Vida, Capacidade Funcional e qualidade de vida de pessoas diagnosticadas com esquizofrenia em função do contexto de inserção. Hospital Psiquiátrico versus estruturas residenciais de reabilitação.

A esquizofrenia é considerada uma das mais graves e debilitantes doenças psiquiátricas, afectando cerca de 1% da população, na maioria dos países ocidentais. Ao longo dos tempos têm sido desenvolvidas várias respostas e políticas sociais para responder a esta problemática, nem sempre eficientes e efectivas. A análise do sistema de prestação de cuidados de saúde mental em Portugal mostra uma evolução positiva na forma de perspectivar os cuidados a estas pessoas, centrado actualmente nos modelos de base comunitária e na implementação de programas de reabilitação psicossocial que potenciam a adopção de estilos de vida saudáveis e mais adaptativos, com consequente melhoria do seu funcionamento e qualidade de vida. Isto não significa no entanto, que não haja ainda muito a fazer na universalização destes pressupostos e na sua validação, assente nos princípios de uma prática baseada na evidência. Este estudo tem como objectivo verificar se os programas de reabilitação residencial interferem de forma significativa no estilo de vida, na qualidade de vida e na capacidade funcional de pessoas com diagnóstico de esquizofrenia. Para tal foram avaliadas 13 pessoas integradas em residências de reabilitação e 13 pessoas em hospital psiquiátrico (Casa de Saúde Rainha Santa Isabel), utilizando o questionário de Estilos de Vida na Esquizofrenia (Valente, Queirós, & Marques, 2009) e as versões portuguesas do WHOQOL-bref (Vaz-Serra e colaboradores 2006) e o Life Skills Profile (Rocha, Queirós, Aguiar, & Marques, 2006). A análise dos resultados parece apontar para a existência de diferenças pouco significativas entre os dois grupos na avaliação de Estilos de Vida. As diferenças são mais significativas no nível de qualidade de vida percepcionada, em todos domínios analisados e no Somatório Geral do questionário; e no que reporta à capacidade funcional, em particular na subescala do auto-cuidado, da responsabilidade e no somatório do teste de Life skills Profile. Em jeito de síntese parece assim que as estruturas residências de reabilitação parecem contribuir para a melhoria da capacidade funcional e qualidade de vida das pessoas lá integradas, por comparação com as que se encontram a residir em hospital psiquiátrico.

Os efeitos de um programa de exercício supervisionado em indivíduos com factores de risco cardiovascular no Hospital da Santa Casa da Misericórdia de Arouca

Introdução: Estudar os factores de risco cardiovasculares (FRCV), permitem tomar medidas preventivas em relação ao estado de saúde, contribuindo para a melhoria da qualidade de vida dos indivíduos e ajudando a prevenir a ocorrência de um evento cardiovascular. Objectivo: O principal objectivo deste estudo é comprovar se o programa de exercício físico supervisionado melhora a condição física e a capacidade funcional. Como objectivo secundário, foi analisada a correlação existente entre as diferentes variáveis, após realização do programa. Métodos: Vinte sujeitos de Arouca, constituíram a amostra do estudo, dividindo-se em grupo de controlo (n=10) e grupo experimental (n=10). Todos os indivíduos receberam informação para controlo e prevenção dos FRCV, através de palestras educacionais. Apenas o grupo experimental participou no programa de exercício, com a duração de 12 semanas / 36 sessões. Foi feito o levantamento e registo dos valores das provas de esforço (Frequência Cardíaca (FC) máxima, equivalente metabólicos (MET´s) máximos e duplo produto (DP) máximo), avaliação antropométrica (índice de massa corporal (IMC), perímetro abdominal, peso, gordura visceral, massa muscular, gordura total), FRCV (Tensão Arterial, colesterol total, colesterol HDL, triglicerídeos, proteína C reactiva) e os níveis de ansiedade e depressão antes e após o programa. Por fim, verificou-se a correlação entre as variáveis. Foi utilizada a estatística inferencial e um nível de significância de 5% (α=0,05). Resultados: Na análise comparativa intergrupo da variável diferença (MII-MI), registaram-se diminuições estatisticamente significativas da variável perímetro abdominal (p=0,02) e aumento estatisticamente significativo da variável MET´s máximo (p=0,01). As principais correlações foram encontradas entre as variáveis antropométricas: peso – gordura visceral (r2=0,824; p<0,001), peso – perímetro abdominal (r2=0,560; p=0,013), peso – IMC (r2=0,527; p=0,017), IMC – peímetro abdominal (r2=0,770; p=0,001). Conclusões: Conclui-se que o programa de exercício parece aumentar a tolerância ao esforço máximo e diminui o perímetro abdominal dos indivíduos em estudo.

Impact of socioeconomic status on Brazilian elderly health

OBJECTIVE: To investigate the impact of socioeconomic status on elderly health. METHODS: The study was based on cross-sectional data from Survey on Health, Well-Being, and Aging in Latin America and the Caribbean. The sample comprised 2,143 non-institutionalized elderly aged 60 years and older living in the urban area of São Paulo, southeastern Brazil. Linear regression models estimated the effect of socioeconomic status indicators (years of schooling completed, occupation and purchasing power) on each one of the following health indicators: depression, self-rated health, morbidity and memory capacity. A 5% significance level was set. RESULTS: There was a significant effect of years of education and purchasing power on self-rated health and memory capacity when controlled for the variables number of diseases during childhood, bed rest for at least a month due to health problems during childhood, self-rated health during childhood, living arrangements, sex, age, marital status, category of health insurance, intake of medicines. Only purchasing power had an effect on depression. Despite the bivariate association between socioeconomic status indicators and number of diseases (morbidity), this effect was no longer seen after including the controls in the model. CONCLUSIONS: The study results confirm the association between socioeconomic status indicators and health among Brazilian elderly, but only for some dimensions of socioeconomic status and certain health outcomes.

Eventos adversos a antibióticos em pacientes internados em um hospital universitário

OBJETIVO: Antibióticos são os medicamentos que mais causam eventos adversos, gerando problemas aos pacientes e custos adicionais ao sistema de saúde. Assim, objetivou-se analisar a ocorrência de eventos adversos a antibióticos em pacientes internados em um hospital. MÉTODOS: Realizou-se monitoramento intensivo do uso de antibióticos em pacientes adultos internados no município de Maringá, Paraná, de setembro de 2002 a fevereiro de 2003. Foram pesquisadas variáveis relativas aos medicamentos em uso, em particular aos antibióticos e aos eventos adversos. Com base em critérios para a avaliação do uso correto dos antibióticos, os eventos observados foram classificados como reações adversas, erros de medicação e "quase erros". Para relação de causalidade entre a administração do fármaco e o surgimento dos eventos utilizou-se o algoritmo de Naranjo. RESULTADOS: Foram acompanhados 87 pacientes e identificados 91 eventos adversos, sendo três deles (3,3%) reações adversas a medicamentos, sete (7,7%) erros de medicação, e 81 (89,0%) "quase erros". As reações a medicamentos ocorreram devido ao uso de quinolonas e foram consideradas "prováveis" utilizando-se o algoritmo de Naranjo. Os sete erros de medicação ocorreram devido a quatro prescrições incorretas de dose e três interações medicamentosas. CONCLUSÕES: Os resultados sugerem que a falta de conhecimento do medicamento ou a falta de informação sobre o paciente no momento da prescrição tenham sido os principais fatores envolvidos na ocorrência das reações a medicamentos.

Risk-factors for antepartum fetal deaths in the city of São Paulo, Brazil

OBJECTIVE: To assess risk factors for antepartum fetal deaths. METHODS: A population-based case-control study was carried out in the city of São Paulo from August 2000 to January 2001. Subjects were selected from a birth cohort from a linked birth and death certificate database. Cases were 164 antepartum fetal deaths and controls were drawn from a random sample of 313 births surviving at least 28 days. Information was collected from birth and death certificates, hospital records and home interviews. A hierarchical conceptual framework guided the logistic regression analysis. RESULTS: Statistically significant factors associated with antepartum fetal death were: mother without or recent marital union; mother's education under four years; mothers with previous low birth weight infant; mothers with hypertension, diabetes, bleeding during pregnancy; no or inadequate prenatal care; congenital malformation and intrauterine growth restriction. The highest population attributable fractions were for inadequacy of prenatal care (40%), hypertension (27%), intrauterine growth restriction (30%) and absence of a long-standing union (26%). CONCLUSIONS: Proximal biological risk factors are most important in antepartum fetal deaths. However, distal factors - mother's low education and marital status - are also significant. Improving access to and quality of prenatal care could have a large impact on fetal mortality.

Long-stay patients in a psychiatric hospital in Southern Brazil

OBJECTIVE: To describe the demographic profile, social functioning, and quality of life of a population of long-stay care patients in a psychiatric hospital. METHODS: A study was carried out in Porto Alegre, Southern Brazil, in 2002. A total of 584 (96%) long-stay patients were assessed by means of the following instruments: the World Health Organization Quality of Life, the Social Behavior Schedule, the Independent Living Skills Survey, the Brief Psychiatric Rating Scale and another instrument for assessing disability (Questionnaire for Assessing Physical Disability). RESULTS: The average hospital stay was 26 years (SD: 15.8) and 46.6% of inpatients had no physical disability. Patients had their social functioning skills and autonomy largely impaired. Few of them (27.7%) answered the instrument for assessing quality of life, and showed significant impairments in all domains. The Brief Psychiatric Rating Scale evidenced a low prevalence of positive symptoms in this population. CONCLUSIONS: The institutionalized population studied presented significantly impaired social functioning, autonomy, and quality of life. These aspects need to be taken into consideration while planning for their deinstitutionalization.