Comparing knowledge and attitudes to dementia care in Brazilian and UK GPs to guide future decisions about educational interventions.

Background: Dementia training for Brazilian general practitioners (GPs) is underdeveloped. We investigated knowledge and attitudes to dementia management among Brazilian GPs and compared these with previous UK findings to inform future decisions about how training is structured.Methods: A total of 115 Brazilian GPs were asked to complete a Portuguese translation of a questionnaire previously used in the UK. This comprised a 14-item multiple-choice knowledge quiz, and a 5-point Likert-scale questionnaire assessing attitudes across 10 dementia management domains. Exploratory factorial analysis was conducted for attitudes.Results: Attitudes toward dementia demonstrated the same underlying factor structure, "heartsink" and "heartfelt" factors, in Brazil as in previous UK studies, explaining 61.6% of variance in responses. Knowledge scores were negatively correlated with heartfelt and heartsink factors.Conclusions: Greater knowledge about dementia was associated with some pessimism about dementia care. The similarity in the structure of attitudes toward dementia management between Brazilian and UK GPs provides a starting point for shared educational approaches targeting attitudes.

Suggested instruments for General Practitioners in countries with low schooling to screen for cognitive impairment in the elderly.

BACKGROUND: General Practitioners (GPs) from underdeveloped countries apply cognitive impairment (CI) assessment tools translated and adapted to cultural setting from other idioms, mainly English. As schooling in elderly from underdeveloped countries tends to be relatively heterogeneous, it is necessary to establish normative and cut-off scores for these CI instruments that are based on studies conducted locally. Some CI screening instruments frequently used by Brazilian specialists in dementia were analyzed to determine which could be most useful to GPs in their working sets. METHOD: Two hundred forty-eight patients aged 65 years or older that had been assisted by GPs in a tertiary hospital in Brazil were evaluated. Based on the MMSE and/or Short-IQCODE scores, 52 probable cases were identified on the basis of clinical data, performances on the neuropsychological tests and questionnaires (Functional Assessment Questionnaire/FAQ, Category Verbal Fluency/CVF, Clock Drawing Test/CDT) and blood tests and brain CT. RESULTS: The combination of a functional questionnaire with a cognitive instrument had higher sensitivity and specificity than using the instruments alone. A FAQ cut-off of 3 in conjunction with a CDT cut-off of 6 proved optimal (93% sensitivity and 92.5% specificity). A higher specificity (93.5%) was attained using a combination of the FAQ (cut-off of 3) with the CVF (cut-off of 10). CONCLUSIONS: For low schooling elderly, the combination of the FAQ and CVF represented a very simple method of increasing the chances of correct screening. For those with higher schooling, the combination of the FAQ and CDT was more suitable.

Older adults with dementia: knowledge and attitudes of physicians in health units.

OBJECTIVE: To describe the knowledge and attitudes of general practitioners of the basic health network of the city of São Paulo in relation to patients with dementia and identify patterns of attitudes. METHODS: A total of 10% of the basic health units in the city of São Paulo (n = 45) were randomly distributed into six regional health coordination centers. Up to two general practitioners were interviewed in each unit, with a total of 81 physicians interviewed. They answered the translated and cross-culturally adapted version for Brazil of two British questionnaires, the knowledge quiz (knowledge about dementias) and the attitude quiz (attitude towards the patient afflicted with dementia), as well as a sociodemographic and occupational questionnaire to understand the profile of general practitioners working in primary care. Descriptive data analysis, factor analysis of the main components of the attitude quiz and study of association between attitudes and knowledge were performed, in addition to the multiple linear regression test to determine the relationship between occupational profile and knowledge about attitude patterns in dementia. RESULTS: The physicians interviewed had a median of five-year graduation time; 35.8% worked exclusively with primary care, and less than 40% had completed, or were attending, medical residency or specialization. Physicians showed a lower knowledge about the diagnosis of dementia than about the epidemiology of the disease and its therapeutic management. Their attitudes towards patients afflicted with dementia resulted in four factors: proactive optimism, delegated optimism, implicit dismay, and explicit dismay. The regression study showed that the attitude of explicit dismay decreases the longer the weekly working hours of the physician in the units, and that the delegated optimistic attitude of the physician decreases in the same situation. CONCLUSION: Investment in training is essential to improve physicians' performance in the field of dementia in primary care.

Health-related quality of life predictors during medical residency in a random, stratified sample of residents.

OBJECTIVE: To evaluate the quality of life during the first three years of training and identify its association with sociodemographicoccupational characteristics, leisure time and health habits. METHOD: A cross-sectional study with a random sample of 128 residents stratified by year of training was conducted. The Medical Outcome Study -short form 36 was administered. Mann-Whitney tests were carried out to compare percentile distributions of the eight quality of life domains, according to sociodemographic variables, and a multiple linear regression analysis was performed, followed by a validity checking for the resulting models. RESULTS: The physical component presented higher quality of life medians than the mental component. Comparisons between the three years showed that in almost all domains the quality of life scores of the second year residents were higher than the first year residents (p < 0.01). The mental component scores remained high for third year residents (p < 0.01). Predictors of higher quality of life were: second or third year of residency, satisfaction with the training program, sufficient time for leisure, and care of critical patients for less than 30 hours per week. CONCLUSION: The mental component of quality of life was the most impaired component, indicating the importance of caring for residents' mental health, especially during their first year and when they are overloaded with critical patients.

The needs of members of the families of general hospital inpatients.

CONTEXT AND OBJECTIVE: The needs of members of the families of intensive care unit patients have been studied, but little is known about the needs of members of the families of general hospital inpatients, especially patients with chronic diseases. The aim of this study was to identify the needs of members of the families of general hospital inpatients and investigate associations between these needs and the patients' clinical and psychiatric profiles. DESIGN AND SETTING: Descriptive study, in a public teaching hospital. METHODS: A random sample of 47 patients and members of their families was studied. Family members' needs were investigated using the critical care family needs inventory and the patients' clinical profiles were investigated using the hospital anxiety and depression scale, confusion assessment method and Karnofsky performance status. The frequencies of family members' needs were described and the patients' clinical and psychiatric characteristics were correlated with the needs using the chi-squared test. RESULTS: Chronic patients predominated and the needs for reassurance and information were indicated as the most important by all members of their families. No associations were found between the patients' characteristics and the needs of members of their families during the hospitalization. CONCLUSIONS: The needs indicated by members of the families of general hospital inpatients were similar to those of members of the families of patients in intensive care units: they considered it very important to be reassured and kept informed throughout the hospitalization.

Interns' depressive symptoms evolution and training aspects: a prospective cohort study.

OBJECTIVE: To study depression symptoms' incidence of medical interns (first year of medical residency) and its correlation with occupational characteristics, satisfaction and stress about their training program. METHODS: Prospective Cohort Study conducted at Escola Paulista de Medicina, Universidade Federal de São Paulo. First year residents, N = 166, from a teaching hospital were invited to answer the Beck Depression Inventory (BDI) and an occupational questionnaire in a prospective longitudinal study. BDI score variation was related with socio-demographic aspects and occupational characteristics using linear regression models. RESULTS: 111 subjects participated (67%); the BDI-score increased in 8 months (mean = 2.75 ± 3.29 vs. 7.00 ± 5.66; p<0.0001). The depressive symptoms' incidence was 9.01% (score>15). BDI-score variation had mean = 4.25 ± 4.93, ranging from -8 to 28. Residents not satisfied with professional training acquired (ß = 3.44; p = 0.004), with their personal life (ß = 2.97; p = 0.001), or who felt stressed in the relationship with senior residents (ß = 2.91; p = 0.015) presented 3 more points of BDI-score after 8 months comparing to those without these perceptions; and being unsatisfied with the nursing team increased BDI-score after 8 months in 2 more points (ß = 1.95; p = 0.025). CONCLUSION: Among the factors that interfere with depression in interns is the occupational characteristics, which might be enhanced by the training facility. Addressing these dissatisfaction and stressful issues should help the university provide better care of interns' mental health.

Common mental disorder among family carers of demented older people in Brazil.

OBJECTIVE: Population aging is a global phenomenon associated with a rising prevalence of chronic degenerative diseases such as dementia. Dementia poses a challenge not only for patients but also their family caregivers who, in exercising this role, are at higher risk of mental illness. The present study investigated the prevalence of common mental disorders (CMD) in family caregivers of demented elderly seen at a geriatric outpatient clinic of a Brazilian teaching hospital. METHODS: A cross-sectional study was conducted in which the following assessment instruments were applied: the Self Reporting Questionnaire, Zarit Burden Interview, Hospital Anxiety and Depression Scale and Mini-Mental State Examination (caregivers aged ≥65 years) plus a sociodemographic questionnaire. RESULTS: The sample comprised 90 caregivers; 83 (92.2%) women, 51 (56.7%) married, 60 (66.7%) son/daughter of elder and 62 (68.6%) holding another job besides caring for the demented elder. Caregivers had a mean age of 57.3 (±11.7) years and mean education of 9.5 (±4.9) years; 62.2% of caregivers were diagnosed with common mental disorder, 50% exhibited anxiety symptoms, 52.2% depression symptoms and 66.7% reported burden. Caregivers with common mental disorder had higher scores on the anxiety, depression and burden scales (p<0.01). Logistic regression showed that caregivers with anxiety symptoms were 15 times more likely to present common mental disorder (OR: 15.0; 95% CI: 3.5-71.2) and caregivers with symptoms of depression were 8 times more likely to have CMD (OR: 8.0; 95% CI: 2.1-31.1). CONCLUSION: Results revealed a high prevalence of common mental disorder in the population studied.

OBJETIVO: O envelhecimento populacional é um fenômeno mundial que está associado ao aumento da prevalência de doenças crônico-degenerativas, como as demências. Demências desafiam não somente os pacientes, mas também seus familiares cuidadores que, como consequência, estão em maior risco de adoecimento mental. O estudo verificou a prevalência de transtorno mental comum em familiares cuidadores de idosos com demência acompanhados em ambulatórios de geriatria de um hospital-escola brasileiro. MÉTODOS: Neste estudo transversal, os instrumentos de avaliação utilizados foram: Self Reporting Questionnaire, Zarit Burden Interview, Hospital Anxiety and Depression Scale e Mini-Exame do Estado Mental (cuidadores com 65 anos ou mais) e questionário sócio demográfico. RESULTADOS: A amostra foi composta por 90 cuidadores; 83 (92,2%) era do sexo feminino, 51 (56,7%) casados, 60 (66,7%) filhos(as) do idoso e 62 (68,6%) possuíam alguma ocupação além de cuidar do idoso dementado. A média de idade foi 57,3 (±11,7) anos e a média de escolaridade foi de 9,5 (±4,9) anos; 62,2% dos cuidadores apresentaram transtorno mental comum, 50% apresentaram sintomas de ansiedade, 52,2% apresentaram sintomas de depressão e 66,7% apresentaram sobrecarga. Cuidadores com transtorno mental comum apresentaram escores maiores nos instrumentos de ansiedade, depressão e sobrecarga (p<0,01). Regressão logística mostrou que cuidadores com sintomas de ansiedade tiveram 15 vezes mais chances de apresentar TMC (OR: 15,0; IC95%: 3,5-71,2) e cuidadores com sintomas de depressão tiveram 8 vezes mais chances de apresentar TMC (OR: 8,0; IC95%: 2,1-31,1). CONCLUSÃO: Resultados encontrados demonstram que, na população estudada, existe alta prevalência de transtorno mental comum.

Cross-cultural adaptation of the "Australian National University Alzheimer's Disease Risk Index" for the Brazilian population.

Alzheimer's disease (AD) represents a major public health problem and it is therefore crucial that modifiable risk factors be known prior to onset of dementia in late-life. The "Australian National University - Alzheimer's Disease Risk Index" (ANU-ADRI) is one of the potential tools for primary prevention of the disease. OBJECTIVE: The aim of this study was to devise an adapted version of the ANU-ADRI for use in Brazil. METHODS: The instrument was translated from its original language of English into Portuguese and then back-translated into English by bilingual translators. It was subsequently reviewed and evaluated as to the degree of translation issues and equivalence. In this study, the ANU-ADRI was applied using individual (face-to-face) interviews in a public hospital, unlike the original version which is applied online by self-report. The final version (pretest) was evaluated in a sample of 10 participants with a mean age of 60 years (±11.46) and mean education of 11 years (±6.32). RESULTS: The intraclass correlation coefficient (ICC) (inter-rater) was 0.954 (P<0.001 for a confidence interval (CI) of 95%=[0.932; 0.969]). Cultural equivalence was performed without the need for a second instrument application step. CONCLUSION: After cross-cultural adaptation, the language of the resultant questionnaire was deemed easily understandable by the Brazilian population.

A doença de Alzheimer (DA) tem sido um grande problema de saúde pública, portanto é crucial que fatores de risco modificáveis possam ser conhecidos antes da instalação da demência na fase final da vida. O "Australian National University - Índice de Risco da Doença de Alzheimer" (ANU-ADRI) é uma das ferramentas potenciais para a prevenção primária da doença. OBJETIVO: Este estudo teve como objetivo elaborar uma versão adaptada do ANU-ADRI para o uso no Brasil. MÉTODOS: O instrumento foi traduzido do idioma original, inglês para a língua portuguesa e retrotraduzido para o inglês por tradutores bilíngues. Foi posteriormente revisado e avaliado quanto ao grau de dificuldade da tradução e equivalência. Neste estudo, o ANU-ADRI foi aplicado em entrevistas individuais (face a face) num hospital público em vez da versão original que é aplicada on-line por meio de autorrelato. A versão final (pré-teste) foi avaliada numa amostra de 10 participantes com média de idade 60 anos (±11,46), e média de escolaridade 11 anos (±6,32). RESULTADOS: O coeficiente de correlação intraclasse entre os avaliadores foi 0,954 (P<0,001, intervalo de confiança de 95% IC=[0,932; 0,969]). A equivalência cultural foi realizada sem a necessidade de uma segunda etapa de aplicação do instrumento. CONCLUSÃO: Após a adaptação transcultural, a linguagem do questionário é descrita como de fácil compreensão pela população brasileira.

PERSONALITY TRAITS, ANGER AND PSYCHIATRIC SYMPTOMS RELATED TO QUALITY OF LIFE IN PATIENTS WITH NEWLY DIAGNOSED DIGESTIVE SYSTEM CANCER.

BACKGROUND: The presence of psychiatric symptoms, anger, and personality characteristics are factors that affect the quality of life of newly diagnosed digestive system cancer patients. OBJECTIVE: This study aims to identify which stable characteristics of the individual's personality interfere with quality of life, even when reactive emotional characteristics of falling ill are controlled. METHODS: A cross-sectional study was performed at the Oncology Clinic ( Hospital das Clínicas ), Marília/SP, Brazil, in which 50 adult patients with digestive system cancer and diagnosed less than 6 months answered the State-Trait Anger Expression Inventory, Temperament and Character Inventory, Hospital Anxiety and Depression Scale and WHOQOL-BREF. Multiple regression was performed to verify if quality of life was related to stable characteristics of the subject's personality (anger trait, temperament and character) after controlling to the transient emotional aspects (anger state, psychiatric symptoms). RESULTS: The quality of life psychological health score was higher in presence of self-directedness character and reward dependence temperament and quality of life environment score was higher in presence of self-directedness character and lower in presence of harm avoidance temperament. CONCLUSION: The psychological well-being and the adaptive needs to the environment that favoring a better quality of life were reinforced mainly by the self-directedness character; which means that patients more autonomous cope better with the disease. On the other hand, the harm avoidance temperament (meaning the patient has fear of aversive situations) impaired the adaptive capacity to deal with the changes of the day-to-day imposed by the disease. Understanding these personality traits is important to the health professionals drive the patient to more successful treatment.

Mild cognitive impairment and progression to dementia of Alzheimer's disease.

The increase in life expectancy in the Brazilian population raises questions about the preparation of the public health system in identifying elderly patients with signs of cognitive impairment. Currently, as a consequence of the long duration of preclinical phase of Alzheimer's disease, efforts of early detection have been emphasized. Clinical dementia presents an important impact on the individual's caregivers, family, society and economy. Identifying individuals who already have some cognitive impairment, despite remaining functional, as well as analyzing associated comorbidities, constitutes an opportunity to analyze possibilities for future interventions. Dementias are clinical conditions that impose a burden on the health system with its high costs, whereas the identification of individuals with cognitive impairment without dementia can aid patients and their families to plan the future and mitigate costs. This narrative revision can provide general practitioners with more information on the subject.

Knowledge and attitudes towards dementia among final-year medical students in Brazil.

OBJECTIVE:: Among all countries, Brazil is expected to have the sixth largest elderly population in 2025. Dementia syndromes are prominent among aging-related diseases. Despite the necessity of and curriculum for training in geriatric medicine to make recommendations on an approach to this theme, adequate training appears to be infrequent. The present study aimed to evaluate the knowledge about dementia and students' attitude towards it during the last semester of the medical course in two of the most important Brazilian medical schools. METHOD:: In our study, a sample of 189 students was invited to complete questionnaires comprising demographic and professional topics, knowledge with respect to cognitive alterations in the elderly and attitudes in dealing with an elderly patient with dementia. RESULTS:: A total of 155 students accepted to participate in the study; 92(59.7%) considered that they had good training in cognitive alterations during their undergraduate medical course, while 67 (58.8%) of them declared having had only theoretical training. Regarding knowledge, the students obtained a mean of 6.9, out of a scale from 0 to 14 points. As for attitudes, the students agreed that they can contribute to the life quality of the patient and of the caregiver, and that it is useful to provide the diagnosis to the family. CONCLUSION:: The findings of this study are relevant for overturn the educational barriers of physicians in relation to the care of patients with dementia.

Knowledge and attitudes towards dementia in a sample of medical residents from a university-hospital in São Paulo, Brazil.

An estimated 61% of the 24.3 million people diagnosed with dementia worldwide live in underdeveloped countries, including Brazil, where a public healthcare system covers the majority of the population. This care is usually provided by General Practitioners (GP) and in Brazil many doctors recently graduated from medical school and residents of different medical specialties practice as GPs. OBJECTIVE: The aim of this study was to describe the knowledge and attitudes about dementia in a sample of Brazilian medical residents from a university-hospital in São Paulo, Brazil. METHODS: A total of 152 Brazilian medical residents participated in the study. Participants answered a "Knowledge Quiz" (KQ) and "Attitude Quiz" (AQ) about dementia issues, transculturally adapted for use in Brazilian physicians. A descriptive analysis of the correct answers on knowledge and of the attitude aspects was performed. RESULTS: The medical residents showed poor knowledge (<50%) about dementia prevalence and incidence and a good knowledge on disease management and diagnosis. Participants tended to be optimistic about caring for demented patients. CONCLUSION: In this study, it is likely that the physicians' good knowledge about dementia issues is the reason for their optimism dealing with demented patients.

Estima-se que 61% dos 24,3 milhões de pessoas diagnosticadas com demência no mundo vivem em países subdesenvolvidos, incluindo o Brasil, onde o sistema público de saúde (SUS) abrange a maioria da população. Os atendimentos médicos no SUS são realizados, habitualmente, por médicos generalistas. No Brasil, muitos médicos, logo após a graduação e residentes de diferentes especialidades médicas trabalham como médicos generalistas. OBJETIVO: O objetivo deste estudo foi descrever o conhecimento e as atitudes sobre demência em uma amostra de médicos residentes brasileiros de um hospital universitário em São Paulo, Brasil. MÉTODOS: 152 médicos residentes participaram do estudo respondendo a um instrumento sobre conhecimentos e atitudes sobre demências que havia sido adaptado transculturalmente para ser usado no Brasil. Uma análise descritiva das respostas corretas sobre conhecimentos e atitudes foi realizada. RESULTADOS: Os médicos residentes mostraram pouco conhecimento (<50%) sobre a prevalência e incidência de demência e maior conhecimento em gerenciamento e diagnóstico. Os profissionais tenderam a ser otimistas sobre como cuidar de pacientes com demência. CONCLUSÃO: Neste estudo, provavelmente, o bom conhecimento sobre algumas questões de demência é a razão para esses médicos sentirem-se mais otimistas com o cuidado aos pacientes com demência.

Brazilian transcultural adaptation of an instrument on physicians' knowledge and attitudes towards dementia.

OBJECTIVE: The aim of this study was to obtain a Brazilian transcultural adaptation of an instrument developed in the United Kingdom for assessing the knowledge and attitudes towards dementia by physicians. METHODS: The "Knowledge Quiz" (KQ) contains 14 items on epidemiology, diagnosis and management of dementia, while the "Attitude Quiz" contains 10 sentences about physicians' thoughts on the management of demented patients. The Quizzes were translated, back-translated and the resultant version applied to five physicians. RESULTS: The transcultural equivalence process was performed and four items of the KQ needed adapting to the Brazilian context. After changes suggested by a panel of specialists, the final version was applied to another five physicians and the transcultural equivalence considered adequate. CONCLUSION: The Brazilian version of the instrument was successfully transculturally adapted for future validation and application in Brazil.

OBJETIVO: Este estudo objetivou obter a adaptação transcultural de um instrumento desenvolvido no Reino Unido para avaliar o conhecimento e as atitudes dos médicos brasileiros diante de pacientes com demência. MÉTODOS: O "Questionário de Conhecimento" (QC) tem 14 itens sobre epidemiologia, diagnóstico e tratamento da demência; e o "Questionário de Atitudes" tem 10 sentenças sobre os pensamentos dos médicos no cuidado de pacientes com demência. Eles foram traduzidos, retrotraduzidos e uma versão foi aplicada para cinco médicos. RESULTADOS: A equivalência transcultural foi realizada, e quatro itens do QC precisaram ser adaptados para o contexto brasileiro. Após as mudanças sugeridas por um comitê de especialistas, a versão final foi aplicada para outros cinco médicos e a equivalência transcultural foi considerada adequada. CONCLUSÃO: A versão brasileira do instrumento foi adaptada transculturalmente com sucesso e está pronta para ser validada e aplicada no Brasil.

Older adults with dementia: knowledge and attitudes of physicians in health units / Idosos com demência: conhecimentos e atitudes dos médicos nas unidades de saúde

ABSTRACT OBJECTIVE: To describe the knowledge and attitudes of general practitioners of the basic health network of the city of São Paulo in relation to patients with dementia and identify patterns of attitudes. METHODS: A total of 10% of the basic health units in the city of São Paulo (n = 45) were randomly distributed into six regional health coordination centers. Up to two general practitioners were interviewed in each unit, with a total of 81 physicians interviewed. They answered the translated and cross-culturally adapted version for Brazil of two British questionnaires, the knowledge quiz (knowledge about dementias) and the attitude quiz (attitude towards the patient afflicted with dementia), as well as a sociodemographic and occupational questionnaire to understand the profile of general practitioners working in primary care. Descriptive data analysis, factor analysis of the main components of the attitude quiz and study of association between attitudes and knowledge were performed, in addition to the multiple linear regression test to determine the relationship between occupational profile and knowledge about attitude patterns in dementia. RESULTS: The physicians interviewed had a median of five-year graduation time; 35.8% worked exclusively with primary care, and less than 40% had completed, or were attending, medical residency or specialization. Physicians showed a lower knowledge about the diagnosis of dementia than about the epidemiology of the disease and its therapeutic management. Their attitudes towards patients afflicted with dementia resulted in four factors: proactive optimism, delegated optimism, implicit dismay, and explicit dismay. The regression study showed that the attitude of explicit dismay decreases the longer the weekly working hours of the physician in the units, and that the delegated optimistic attitude of the physician decreases in the same situation. CONCLUSION: Investment in training is essential to improve physicians' performance in the field of dementia in primary care.

RESUMO OBJETIVO: Descrever os conhecimentos e atitudes dos médicos generalistas da rede básica de saúde da cidade de São Paulo em relação a pacientes com demência e identificar padrões de atitudes. MÉTODOS: Foram sorteadas aleatoriamente 10% das unidades básicas de saúde da cidade de São Paulo (n = 45), distribuídas proporcionalmente em seis coordenadorias regionais de saúde. Foram entrevistados até dois médicos generalistas em cada unidade, obtendo-se ao todo 81 médicos entrevistados. Eles responderam à versão traduzida e adaptada transculturalmente para o Brasil de dois questionários britânicos, o knowledge quiz (conhecimentos sobre demências) e o attitude quiz (atitudes frente ao paciente dementado), além de um questionário sociodemográfico e ocupacional para o entendimento do perfil dos médicos generalistas que atuam na atenção primária. Realizaram-se análise descritiva dos dados, análise fatorial dos principais componentes do attitude quiz e estudo de associação entre atitudes e conhecimentos, além do teste de regressão linear múltipla para determinar a relação entre o perfil ocupacional e de conhecimento em demência sobre os padrões de atitudes. RESULTADOS: Os médicos entrevistados tinham mediana de tempo de formado de cinco anos; 35,8% trabalhavam exclusivamente com atenção primária, e menos de 40% tinham concluído, ou estavam cursando, residência médica ou especialização. Os médicos mostraram um conhecimento menor sobre diagnóstico de demência do que sobre a epidemiologia da doença e seu manejo terapêutico. Suas atitudes em relação a pacientes dementados resultaram em quatro fatores: otimismo proativo, otimismo delegador, desalento implícito e desalento explícito. O estudo de regressão mostrou que a atitude de desalento explícito diminui quanto maior for a jornada de trabalho semanal do médico nas unidades, e que a atitude otimista delegadora do médico diminui na mesma situação. CONCLUSÕES: O investimento em capacitação é fundamental para melhorar o desempenho do médico no campo da demência na atenção primária.

The relationship between genotype, psychiatric symptoms and quality of life in adult patients with sickle cell disease in São Paulo, Brazil: a cross-sectional study.

CONTEXT AND OBJECTIVE: Health-related quality of life (HRQoL) may be worsened in sickle cell patients due to the presence of psychiatric disorders. The aims of this study were to describe the psychiatric symptoms in Brazilian sickle cell patients and to evaluate the relationship of these symptoms to the genotype of the disease and the subject's HRQoL. DESIGN AND SETTING: Cross-sectional study conducted at the hematology outpatient clinic, Hospital São Paulo. METHODS: Adult patients with sickle cell disease completed the Medical Outcome Study - Short Form 36 and the Patients' Health Questionnaire. Clinical data were gathered from their medical files. Linear regression models were developed to study the dependency of HRQoL domains on the genotype controlling for psychiatric symptoms. RESULTS: In the study period, 110 patients were evaluated. The most frequent psychiatric symptom was depression (30%), followed by anxiety (12.7%) and alcohol abuse (9.1%). Patients with the more severe genotype (SS and Sßthal0) showed lower scores for the "general health" and "role-physical" HRQoL domains, without interference from psychiatric symptoms. In the "role-physical" domain, the more severe genotype operated as a protective factor for HRQoL (ß = 0.255; P = 0.007). CONCLUSION: The more severe genotypes worsened HRQoL in two domains of physical health (general health and role-physical), but they did not have any influence on mental health, thus suggesting that physicians should be more attentive to aspects of HRQoL relating to the functionality of sickle cell disease patients, so as to be aware of the limitations that these patient live with.

Development of psychiatric risk evaluation checklist and routine for nurses in a general hospital: ethnographic qualitative study.

CONTEXT AND OBJECTIVE: There is high prevalence of mental and behavioral disorders in general hospitals, thus triggering psychiatric risk situations. This study aimed to develop a psychiatric risk assessment checklist and routine for nurses, the Psychiatric Risk Evaluation Check-List (PRE-CL), as an alternative model for early identification and management of these situations in general hospitals. DESIGN AND SETTING: Ethnographic qualitative study in a tertiary-level private hospital. METHOD: Three hundred general-unit nurses participated in the study. Reports were gathered through open groups conducted by a trained nurse, at shift changes for two months. The questions used were: "Would you consider it helpful to discuss daily practice situations with a psychiatrist? Which situations?" The data were qualitatively analyzed through an ethnographic approach. RESULTS: The nurses considered it useful to discuss daily practice situations relating to mental and behavioral disorders with a psychiatrist. Their reports were used to develop PRE-CL, within the patient overall risk assessment routine for all inpatients within 24 hours after admission and every 48 hours thereafter. Whenever one item was present, the psychosomatic medicine team was notified. They went to the unit, gathered data from the nurses, patient files and, if necessary, attending doctors, and decided on the risk management: guidance, safety measures or mental health consultation. CONCLUSION: It is possible to develop a model for detecting and intervening in psychiatric and behavioral disorders at general hospitals based on nursing team observations, through a checklist that takes these observations into account and a routine inserted into daily practice.

Clinical and demographic profile of cancer patients in a consultation-liaison psychiatric service.

CONTEXT: An almost 50% prevalence of psychiatric disorders among cancer patients has prompted a series of studies on consultation-liaison psychiatry. Nonetheless, there are few reports on the epidemiological factors involving comorbidity between cancer and psychiatric disorders. OBJECTIVE: To evaluate the epidemiological profile of cancer inpatients referred to the consultation-liaison psychiatric service in an oncology hospital during its first year of activity. TYPE OF STUDY: Descriptive study. SETTING: Tertiary-care teaching hospital. PARTICIPANTS: 319 patients referred 412 times to the consultation-liaison psychiatry service. PROCEDURES: From August 97 to July 98, an appraisal was made of data on all admissions registered at the Hospital do C ncer, and also all referrals registered at the consultation-liaison psychiatry service. MAIN MEASUREMENTS: The demographics and patients' clinical data, the type and flow of the request, and the evaluation conducted by the service were analyzed and comparisons with the hospital data were made. The distribution of the number of referrals was used to construct a profile of patients who had repeatedly used the service. RESULTS: Psychiatric diagnoses were found in 59% of the cases. Forty-three percent of these required medication, 18.3% needed psychotherapy, 22.1% family intervention and 20.5% guidance from the staff. Over 22.8% of the consultations were reevaluations, mainly involving younger male patients with worst prognoses. These patients required lengthier and more elaborate intervention, and had higher prevalence of depressive and behavioral disorders. CONCLUSION: A younger and mainly male population of non-surgical oncological cases was referred to the consultation-liaison psychiatric service during its first year of activity. The psychiatric disorder prevalence was higher than expected, and consisted predominantly of mood disorders. We detected a priority group, namely the reevaluated patients, who deserved special attention throughout the psychiatric interventions.

Interns' depressive symptoms evolution and training aspects: a prospective cohort study

SUMMARY OBJECTIVE To study depression symptoms' incidence of medical interns (first year of medical residency) and its correlation with occupational characteristics, satisfaction and stress about their training program. METHODS Prospective Cohort Study conducted at Escola Paulista de Medicina, Universidade Federal de São Paulo. First year residents, N = 166, from a teaching hospital were invited to answer the Beck Depression Inventory (BDI) and an occupational questionnaire in a prospective longitudinal study. BDI score variation was related with socio-demographic aspects and occupational characteristics using linear regression models. RESULTS 111 subjects participated (67%); the BDI-score increased in 8 months (mean = 2.75 ± 3.29 vs. 7.00 ± 5.66; p<0.0001). The depressive symptoms' incidence was 9.01% (score>15). BDI-score variation had mean = 4.25 ± 4.93, ranging from -8 to 28. Residents not satisfied with professional training acquired (β = 3.44; p = 0.004), with their personal life (β = 2.97; p = 0.001), or who felt stressed in the relationship with senior residents (β = 2.91; p = 0.015) presented 3 more points of BDI-score after 8 months comparing to those without these perceptions; and being unsatisfied with the nursing team increased BDI-score after 8 months in 2 more points (β = 1.95; p = 0.025). CONCLUSION Among the factors that interfere with depression in interns is the occupational characteristics, which might be enhanced by the training facility. Addressing these dissatisfaction and stressful issues should help the university provide better care of interns' mental health.

RESUMO OBJETIVO Estudar a incidência de sintomas depressivos em residentes de medicina de 10 ano e sua correlação com características ocupacionais, satisfação e estresse no programa. MÉTODOS Coorte prospectivo realizado na Escola Paulista de Medicina, Universidade Federal de São Paulo. Foram convidados 166 médicos residentes do hospital universitário para responder ao Inventário de Depressão Beck (BDI) e a um questionário ocupacional num estudo prospectivo longitudinal. O escore da variação do BDI foi relacionado com aspectos sociodemográficos e características ocupacionais usando um modelo de regressão linear. RESULTADOS Cento e onze sujeitos participaram (67%); o escore do BDI aumentou em oito meses (média = 2,75 ± 3,29 vs. 7,00 ± 5,66; p<0,0001). A incidência dos sintomas depressivos foi de 9,01% (escore>15). A variação do escore do BDI teve média = 4,25 ± 4,93 (de -8 a 28). Residentes não satisfeitos com o treinamento profissional (β = 3,44; p = 0,004), com a vida pessoal (β = 2,97; p = 0,001) ou que se sentem estressados na relação com residentes seniores (β = 2,91; p = 0,015) apresentaram 3 pontos a mais do escore do BDI depois de oito meses em comparação com aqueles sem tais percepções; estar insatisfeito com a equipe de enfermagem aumentou o escore do BDI em 2 pontos (β = 1,95; p = 0,025). CONCLUSÃO Entre os fatores que interferem na depressão em residentes estão as características ocupacionais que podem ser melhoradas no treinamento. Esclarecer tais pontos pode ajudar a instituição a prover um melhor cuidado em saúde mental.

Investigation of minor psychiatric symptoms in patients with chronic kidney disease on hemodialysis treatment / Investigação de sintomas psiquiátricos menores em pacientes renais crônicos em tratamento hemodialítico

AIMS: To identify sociodemographic characteristics and presence of minor symptoms of anxiety and depression in patients on hemodialysis. METHODS: Cross-sectional study, carried out in the hemodialysis units of the Santas Casas de Misericórdia in Marília and Tupã, São Paulo state, Brazil, with 65 hemodialytic patients, ranging from 20 to 86 years. Initially, the mental state of the participants was evaluated in order to ensure they had conditions to understand the research objectives and to respond to the evaluation instruments. Following, the subjects answered to the socio-demographic and clinical questionnaire and the Hospital Anxiety and Depression Scale. The data were organized using relative and absolute frequencies for the categorical variables, and measures of central tendency and dispersion for the quantitative variables. In order to compare the mean scores according to the studied variables, unpaired Student's t test and Analysis of Variance were used in addition to Mann Whitney U-Test and Kruskal-Wallis test when the distribution did not present normality. The adopted level of significance was 5% (p<0.05). RESULTS: The Hospital Anxiety and Depression Scale for minor symptoms identified 42 patients with anxiety and 45 with depression. The anxiety mean scores were statistically higher in the female (10.23±4.51) than in the male (8.32±3.68) patients (p=0.034). Patients aged 31 to 41 years and 42 to 52 years had higher depression scores (12.20±1.48 and 11.16±2.50 respectively) when compared to patients aged over 52 years (9.23±3.63) and aged 20 to 30 years (5.50±2.12) (p=0.017). Patients who underwent psychotherapeutic treatment had lower scores of anxiety (1.00±1.41) compared to those who had already undergone psychotherapeutic treatment and those had never been under treatment (9.27±3.92 and 12.75±3.40 respectively) (p=0.020). CONCLUSIONS: According to the Hospital Anxiety and Depression Scale, women had higher anxiety mean scores than men. The lowest scores for anxiety and depression were present in the younger and older age groups of women, and those who underwent psychotherapy presented even lower scores. Clinical management in psychotherapy can be a positive contribution to ease the symptoms of anxiety and depression, improving the patients' ability to cope with hemodialysis.

OBJETIVOS: Identificar características sociodemográficas e a presença de sintomas menores de ansiedade e depressão em pacientes em hemodiálise. MÉTODOS: Estudo transversal, realizado nas unidades de hemodiálise das Santas Casas de Misericórdia em Marília e Tupã, estado de São Paulo, com 65 pacientes hemodialíticos, na faixa de idade entre 20 a 86 anos. Inicialmente, foi realizada avaliação do estado mental a fim de identificar se os pacientes estavam em condições de compreender os objetivos da pesquisa e de responder ao questionário sociodemográfico e clínico e a Escala de Ansiedade e Depressão Hospitalar. Os dados foram organizados utilizando frequências relativas a absolutas para as variáveis categóricas e medidas de tendência central e dispersão para as variáveis quantitativas. Para comparação dos escores médios segundo as variáveis estudadas foram utilizados teste t de Student não pareado e Análise de Variância, além do Teste U de Mann Whitney e do teste de Kruskal-Wallis quando a distribuição não apresentava normalidade. O nível de significância adotado foi de 5% (p<0,05). RESULTADOS: A Escala de Ansiedade e Depressão Hospitalar para sintomas menores identificou 42 pacientes com ansiedade e 45 com depressão. As médias dos escores de ansiedade apresentaram-se maiores nas mulheres (10,23±4,51) do que nos homens (8,32±3,68) (p=0,034). Os pacientes com idades de 31 a 41 anos e 42 a 52 anos apresentaram escores de depressão mais elevados (respectivamente 12,20±1,48 e 11,16±2,50) quando comparados aos pacientes com idades acima de 52 anos (9,23±3,63) e com idades entre 20 e 30 anos (5,50±2,12) (p=0,017). Os pacientes que realizam tratamento psicoterápico tiveram escores de ansiedade menores (1,00±1,41) em comparação aos que já haviam realizado o tratamento psicoterápico e aos que não tiveram essa intervenção (respectivamente 9,27±3,92 e 12,75±3,40) (p=0,020). CONCLUSÕES: Conforme a Escala de Ansiedade e Depressão Hospitalar, as mulheres apresentaram, em média, escores de ansiedade maiores. Os menores escores para ansiedade e depressão estavam presentes nas faixas etárias mais jovens e mais velhas, e os que faziam ou já haviam feito psicoterapia apresentaram escores menores. O manejo clínico em psicoterapia pode ser uma contribuição positiva para amenizar os sintomas de ansiedade e depressão, melhorando a capacidade dos pacientes no enfrentamento do tratamento hemodialítico.

Cognitive assessment in an elderly population with metabolic syndrome in Brazil.

Chronic degenerative conditions are very common in the elderly. According to medical literature, there is a correlation between cognitive impairment among elders and arterial hypertension/hyperglycemia which in turn are common diseases among the elderly population worldwide. Nonetheless, data on the association between cognitive impairment and Metabolic Syndrome (MetS) remains controversial. OBJECTIVE: To compare the cognitive status of Brazilian elderly outpatients with and without MetS. METHODS: A cross-sectional case-control study with 49 subjects (25 MetS and 24 controls) who underwent a global geriatric and neuropsychological assessment was carried out. The scores for cognitive abilities (sustained attention, alternating attention, immediate memory, working memory, memory - immediate recall, memory - delayed recall, memory - recognition, executive function, ideomotor praxis, constructive praxis, naming ability, verbal fluency) were compared with the data for the normal population and differences between case and control groups were analyzed using Student's t-test or the Mann-Whitney test. RESULTS: Forty-five patients (91.8%) were female, with a mean age of 73.9±5.9 years, and 3.0±1.0 years of schooling. A significant difference (p<0.01) was found between case and control groups regarding the MetS components. For cognitive abilities, no statistically significant difference was detected between the groups and all subjects presented low cognitive scores. CONCLUSION: The results obtained in the present study showed that MetS was not associated with cognitive impairment in this population. Further prospective studies are necessary to investigate the influence of well-controlled MetS on cognitive performance among elders.

Quadros crônico-degenerativos são prevalentes na população idosa. Estudos prévios tem correlacionado prejuízo cognitivo em idosos com hipertensão e hiperglicemia que por sua vez são doenças bastante comuns do envelhecimento na população mundial. Apesar disso ainda existem dados controversos sobre a associação entre prejuízo cognitivo e síndrome metabólica (SMet). OBJETIVO: Comparar o estado cognitivo de pacientes brasileiros idosos em atendimento ambulatorial com e sem SMet. MÉTODOS: Estudo de caso-controle transversal com 49 pacientes (25 com SMet e 24 controles) que foram submetidos à avaliação geriátrica global e neuropsicológica. Os escores de habilidades cognitivas (atenção sustentada, atenção alternada, memória imediata, memória operacional, memória tardia - evocação imediata, tardia e de reconhecimento -, função executiva, praxia ideomotora, praxia visuo-construtiva, habilidade de nomeação e fluência verbal) foram comparados com dados da população saudável e a diferença entre caso e controle foi analisada usando o teste t de Student ou o teste de Mann-Whitney. RESULTADOS: Quarenta e cinco pacientes (91.8%) foram mulheres com idade média de 73.9±5.9 anos e escolaridade média de 3.0±1.0anos. Observou-se uma diferença significativa (p<0.01) entre os grupos com relação aos critérios da SMet. Com relação às habilidades cognitivas não houve diferença estatística entre os grupos e todos os pacientes apresentaram baixo escore cognitivo. CONCLUSÃO: Os resultados obtidos no presente estudo indicaram que a SMet não foi associada com o prejuízo cognitivo nesta população. Outros estudos prospectivos são necessários para melhor investigar a influência de idosos bem compensados nos componentes da SMet no desempenho cognitivo ao longo do tempo.