Translating measurement into practice: Brazilian norms for depressive symptom assessment with the Patient Health Questionnaire (PHQ-9)

Objectives: To provide practical norms for measuring depressive symptoms with the Patient Health Questionnaire 9 (PHQ-9) in Brazil through a state-of-the-art psychometrics analysis. Methods: We used a large representative dataset from the 2019 Brazilian National Health Survey (Pesquisa Nacional de Saúde - 2019), which included 90,846 Brazilian citizens. To assess scale structure, we assessed a unidimensional model using confirmatory factor analysis. Item response theory was used to characterize the distribution of depressive symptoms. Summed- and mean-based PHQ-9 scores were then linked using item response theory-based scores in generalized additive models. Finally, percentiles, T scores, and a newly developed score, called the decimal score (D score), were generated to describe PHQ-9 norms for the Brazilian population. Results: Confirmatory factor analysis revealed a good fit to the unidimensional model, being invariant to age and sex. Item response theory captured item-level information about the latent trait (reliable from 1 to 3 SDs above the mean). Brazilian norms were presented using summed scores, T scores, and D scores. Conclusion: This is the first study to determine Brazilian norms for the PHQ-9 among a large representative sample using robust psychometric tools. More precise PHQ-9 scores are now available and may be widely used in primary and specialized clinical care settings.

Revisiting global cognitive and functional state 13 years after a clinical trial of lithium for mild cognitive impairment

Objectives: To re-evaluate a sample of older adults enrolled in a randomized controlled trial of lithium for amnestic mild cognitive impairment (MCI) after 11 to 15 years, re-assessing their current (or last available) global cognitive and functional state. Methods: We recalled all former participants of the Lithium-MCI trial conducted by our group between 2009 and 2012 to perform a single-blinded, cross-sectional evaluation of their global clinical state to compare the long-term outcome of those who received lithium vs. those who received placebo. Results: Of the original sample (n=61), we were able to reach 36 participants (59% of retention), of whom 22 had previously received lithium (61% of the recall sample) and 14 (39%) had received placebo. Since 30.5% of the recalled sample was deceased, psychometric data were collected only for 69.5% of the participants. We found statistically significant differences in current mean Mini Mental State Examination score according to previous treatment group (25.5 [SD, 5.3] vs. 18.3 [SD, 10.9], p = 0.04). The lithium group also had better performance in the phonemic Verbal Fluency Test than the control group (34.4 [SD, 14.4] vs. 11.6 [SD, 10.10], p < 0.001). Differences in these measures also had large effect sizes, as shown by Cohen's d values of 0.92 and 1.78, respectively. Conclusion: This data set suggests that older adults with amnestic MCI who had been treated with lithium during a previous randomized controlled trial had a better long-term global cognitive outcome than those from a matched sample who did not receive the intervention.

Ensino de "saúde e espiritualidade" na graduação em medicina e outros cursos da área de saúde / Teaching "spirituality and health" in medical and healthcare undergraduate courses

Introdução: Paralelamente ao avanço da interface "Saúde e espiritualidade" (E/R) no campo de pesquisa, há um crescimento no ensino dessa temática em universidades brasileiras e internacionais. Objetivo: O objetivo desse estudo é fornecer um panorama do ensino de temas relacionados a "saúde e espiritualidade" na graduação em saúde no mundo, com particular enfoque na educação médica brasileira. Material e Métodos: Revisão narrativa baseada na busca em bases de dados nacionais e internacionais, assim como na experiência dos autores. Resultados: Nas últimas décadas houve um crescimento importante na área de ensino em E/R, com um nítido predomínio de países de língua inglesa. Países como Estados Unidos, Canadá e Reino Unido apresentam-se com destaque tanto em pesquisa como no ensino da temática, sendo que as diretrizes seguidas mundialmente partem predominantemente do continente norte-americano. No Brasil, encontramos estudos que abordam a temática na educação médica Brasileira, com um predomínio marcante de estudos transversais abordando professores e estudantes de medicina. A maioria das escolas brasileiras ainda não possui uma inserção consistente da temática na grade curricular, apesar de um levantamento recente mostrar a existência de quarenta e cinco ligas acadêmicas de saúde e espiritualidade pelo Brasil. Conclusão: O tripé acadêmico de pesquisa, ensino e extensão é de vital importância para a produção e disseminação de novos conhecimentos. Na área de E/R não é diferente, com a literatura nacional e internacional mostrando não apenas um crescimento do interesse, mas também do número de escolas médicas que estão inserindo a temática nas bancadas de graduação. Importante para o futuro que o ensino não seja focado apenas no conteúdo teórico, mas que sejam formados profissionais capacitados para lidar com as questões E/R na prática clínica diária

Introduction: In parallel with the advancement of the interface "Health and spirituality" (S/R) in the research field, there is a growth of this subject in Brazilian and international universities. Objective: The objective of this article is to provide a panorama of the teaching of topics related to S/R in Brazilian and international health education, focusing in Brazilian medical schools. Material and Methods: Narrative review using national and international databases, as well as on the authors' experiences. Results: On last decades there is a growth on the field of teaching S/R, with a clear predominance of English-speaking countries. United States, Canada, and the United Kingdom present themselves as a the most prominent countries both on teaching and researching and most of guidelines come from North American continent. In Brazil, we found some studies addressing S/R in Brazilian medical education, with a marked predominance of cross-sectional studies with teachers and medical students. Most of the Brazilian medical schools does not yet present a consistent insertion of the subject on formal curriculum, even though a recent data shows the existence of forty-five academic student groups studying S/R throughout Brazil. Conclusion: The university areas of research, teaching and extension is of vital importance for the production and dissemination of new knowledges. In the area of S/R this is not different, with the national and international literature showing not only a growth of interest, but also in the number of medical schools including the theme in graduation setting. Important to stress that the future teaching should not focus only on theoretical content but also in preparing students able to deal with S/R issues in daily clinical practice.

O Primeiro Ano do Grupo de Apoio ao Primeiranista / The First Year of the Freshman Support Group

Este trabalho é um relato de experiência do primeiro ano de funcionamento do Grupo de Apoio ao Primeiranista (GAP). O GAP é um grupo desenvolvido por alunos de Medicina de uma universidade privada do Estado de São Paulo, apoiado por sua direção, com o intuito de amparar e humanizar a recepção aos ingressantes. O início das atividades do GAP ocorreu em 2013 com base nos conceitos de tutoria/mentoring, aplicado por outras escolas médicas brasileiras. Nas reuniões semanais do GAP, os participantes (alunos do primeiro ano) e mentores (acadêmicos veteranos e uma psicóloga institucional) discutiam temas como resiliência, compaixão, humildade e respeito. Durante as reuniões, notou-se uma problemática extensa em relação ao trote universitário, referido pelos primeiranistas como o pior problema enfrentado na universidade. Na sequência dos encontros, o grupo direcionou suas ações para reduzir o trote na universidade. O GAP, apesar de estar em seu primeiro ano de funcionamento, mostrou ter eficácia relevante, podendo ser um modelo a ser implementado em outras universidades.

This paper reports the experience of the first year of the Freshman Support Group (GAP). GAP was developed by a group of medical students at a private university in the state of Sao Paulo, supported by their coordinators, with the aim of supporting and humanizing the reception of new first-year students. GAP opened in 2013 founded on the concepts of mentoring applied at other Brazilian medical schools. GAP held weekly meetings in which participants (first year medical students), and mentors (both senior students and a psychologist), discussed topics such as resilience, compassion, humility, and respect. During the meetings the students voiced much concern about university hazing; cited as the worst problem faced at university. Following these meetings, the group directed its actions toward reducing hazing at the university. GAP, although only in its first year of operation, proved to be effective and could serve as a model for implementation at other universities.