Spirituality of medical students: associations with empathy and attitudes in the doctor-patient relationship / Espiritualidade dos estudantes de Medicina: associações com empatia e atitude na relação médico-paciente

Abstract: Introduction: Currently, the study of the factors that improve interpersonal relationships in patient care and medical education has been considered relevant and necessary. Understanding what precedes empathy and medical interns' and young doctors' attitudes is a relevant topic for health professionals' education and for their academic and professional performance. Although patients and medical students have indicated that spirituality is an important issue, it is not frequently addressed in medical schools. Objective: This study aims to verify the association between (i) well-being related to spirituality, religiosity and the medical interns' and residents' personal beliefs and (ii) empathy and attitudes in the doctor-patient relationship. Methods: This was a quantitative, cross-sectional, observational study. A total of 64 undergraduate students in the last years of medical school and 50 residents answered the following self-administered instruments: WHOQOL-SRPB, Jefferson Scale of Empathy, and Patient-Practitioner Orientation Scale. Descriptive statistics, Pearson's correlation and stepwise linear regressions were used to analyze data. Results: Significant correlations (p<0.05) varying from weak (r=0.10) to moderate (r=0.39) were found. The WHOQOL-SRPB final score affected the global score of empathy (R2 = 0.12; p <0.00; VIF=1.00). The component meaning and purpose in life affected the global score of the patient-centered attitude (R2= 0.14; p <0.00; VIF=1.00). Conclusions: Spirituality, religiosity and personal beliefs are associated with patient-centered attitudes and medical interns' and residents' empathy. In general, well-being related to spirituality preceded empathy, and the component meaning and purpose in life preceded patient-centered attitudes. These results imply the need to consider well-being related to spirituality in interns' and residents' education for a better doctor-patient relationship.

Resumo: Introdução: Na atualidade, considera-se relevante e oportuno estudar os fatores que contribuem para a melhoria das relações interpessoais no contexto da assistência ao paciente e da educação médica. Compreender os preditores em relação à empatia e à atitude do interno de Medicina e do jovem médico é tema em destaque na formação dos profissionais de saúde, no desempenho acadêmico e profissional. A espiritualidade tem sido apontada como tema importante tanto pelos pacientes como pelos estudantes de Medicina, porém ainda pouco abordada nas escolas médicas. Objetivo: O estudo propõe verificar a associação entre o bem-estar relacionado à espiritualidade, à religiosidade e às crenças pessoais do interno e residente de Medicina e a empatia e a atitude na relação médico-paciente. Métodos: Trata-se de um estudo observacional, transversal, de abordagem quantitativa. O questionário WHOQOL-espiritualidade, religiosidade e crenças pessoais, a Escala Jefferson de Empatia e a Escala de Orientação Médico-Paciente foram autoaplicados por 64 estudantes dos últimos anos do curso e 50 residentes de Medicina. Realizaram-se estatística descritiva, correlação de Pearson e regressão linear stepwise para análise dos dados. Resultados: Foram encontradas correlações significativas (p < 0,05), variando de fracas (r = 0,10) a moderadas (r = 0,39). O escore final do WHOQOL-SRPB apresentou efeito sobre o escore global de empatia (R2 = 0,12; p < 0,00; β = 0,35; VIF = 1,00). Sentido da vida apresentou efeito sobre o escore global da atitude centrada no paciente (R2 = 0,14; p < 0,00; β = 0,38; VIF = 1,00). Conclusão: A espiritualidade, a religiosidade e as crenças pessoais foram associadas à atitude centrada no paciente e à empatia dos internos e residentes de Medicina. Em geral, o bem-estar relacionado à espiritualidade foi preditor da empatia, e o sentido da vida, preditor da atitude centrada no paciente. Esses resultados implicam a necessidade de se considerar o bem-estar relacionado à espiritualidade na formação dos internos e residentes para uma melhor qualidade da relação médico-paciente.

Quality of life in children and adolescents with allergic rhinitis.

UNLABELLED: Allergic rhinitis (AR) remains a significant pediatric health problem because of the burden of uncontrolled symptoms on daily activities and on general well being. AIM: to assess the impact of AR on health-related quality of life (HRQL) of children and adolescents using a generic instrument, the Child Health Questionnaire (CHQ - PF50). METHODS: Between January and November 2004, parents or caregivers of 23 children and adolescents with AR without comorbidities and with positive prick tests for at least one air allergen were invited to participate of a cross-sectional study and asked to answer the self-administered CHQ-PF50. The scores were compared to those of healthy children and adolescents. RESULTS: Patient scores were lower (p<0.05) than healthy subsets in both the physical and psychosocial summaries and in most of the CHQ-PF50 scales (p<0,05), except for the 'change in health' scale. The size effect was higher in the physical score compared to the psychosocial summary score. CONCLUSIONS: allergic rhinitis has a global negative impact on the HRQL of children and adolescents, with major repercussions in physical function; AR also negatively affects family relations.

Quality of life in children and adolescents with allergic rhinitis / Qualidade de vida em crianças e adolescentes com rinite alérgica

Allergic rhinitis (AR) remains a significant pediatric health problem because of the burden of uncontrolled symptoms on daily activities and on general well being. AIM: to assess the impact of AR on health-related quality of life (HRQL) of children and adolescents using a generic instrument, the Child Health Questionnaire (CHQ - PF50). METHODS: Between January and November 2004, parents or caregivers of 23 children and adolescents with AR without comorbidities and with positive prick tests for at least one air allergen were invited to participate of a cross-sectional study and asked to answer the self-administered CHQ-PF50. The scores were compared to those of healthy children and adolescents. RESULTS: Patient scores were lower (p<0.05) than healthy subsets in both the physical and psychosocial summaries and in most of the CHQ-PF50 scales (p<0,05), except for the "change in health" scale. The size effect was higher in the physical score compared to the psychosocial summary score. CONCLUSIONS: allergic rhinitis has a global negative impact on the HRQL of children and adolescents, with major repercussions in physical function; AR also negatively affects family relations.

A rinite alérgica (RA) representa importante problema de saúde pública, compromete as atividades diárias e pode repercutir no bem estar dos pacientes. OBJETIVO: Avaliar o impacto da RA na qualidade de vida relacionada à saúde (QVRS) de crianças e adolescentes por meio do questionário genérico Child Health Questionnaire (CHQ-PF50). CASUÍSTICA E MÉTODOS: Entre janeiro e novembro de 2004 pais ou responsáveis de 23 crianças e adolescentes com RA sem comorbidades e teste cutâneo de hipersensibilidade imediata positivo para pelo menos um aeroalérgeno foram convidados a participar de um estudo transversal e solicitados a responder o CHQ-PF50. Os escores obtidos foram comparados com os de crianças e adolescentes saudáveis. RESULTADOS: Os escores obtidos pelos pacientes foram menores (p<0,05) que os do grupo controle nos sumários físico e psicossocial e na maioria das escalas, com exceção na escala "alteração na saúde". O tamanho do efeito foi maior no escore sumário físico que no psicossocial. CONCLUSÕES: A RA causa impacto negativo global na QVRS de crianças e adolescentes com maior repercussão na função física, e afeta negativamente a dinâmica familiar.

Avaliacao isocinetica dos inversores e eversores de tornozelo: estudo comparativo entre atletas de futebol e sedentarios normais / Body weight influence on respiratory pressures on sitting supine and upright positions

O objetivo deste trabalho foi avaliar os grupos musculares eversores e inversores do tornozelo e fazer uma comparacao das respostas dinamicas de forca e potencia entre os agonistas e antagonistas quanto a dominancia e pratica de futebol. Metodos: foram avaliados 30 individuos do sexo masculino de 17 a 20 anos, sem lesoes, divididos em dois grupos: 15 atletas (categoria juniores) de futebol, idade 18,4 +- 0,8 anos, peso 65 +- 7,3 kg e altura 1,74 +- 0,05m e 15 nao atletas (grupo controle) com idade de 17,6 +- 0,8 anos, peso 65,8 +- 15kg e altura 1,72 +- 0,1m pela dinamometria isocinetica. Os parametros avaliados foram pico de torque (Newton metros-Nm), trabalho (joules - J) e potencia (watts - W) nas velocidades angulares de 30/s e 120/s. Resultados: a relacao dos grupos musculares agonistas/antagonistas quanto a dominancia e atividade futebolistica nao apresentou diferenca significativa. As relacoes entre os grupos inversores/eversores do tornozelo ficaram proximas de 100 (por cento)

[AIDS and HIV infection among homosexual and bisexual men in Belém, Pará, Brazil, 1988-1990]. / SIDA e infecção pelo HIV em homossexuais e bissexuais masculinos em Belém, Pará, Brasil, 1988-1990.

During three years (1988-1990) blood samples from 307 people were taken to test antibodies for Human Immunodeficiency Virus type 1 (HIV-1) in homo and bisexual males living in Belém, being 149 (48.5%) of the former and 158 (51.5%) of the later. All patients requested examinations spontaneously to find out their status. The ages of tested people ranged from 16 to 64 years old. Serologic diagnosis was made using an enzyme immunoassay (Abbott, São Paulo-Brasil) for screening and an indirect immunofluorescence test (FIOCRUZ, Rio de Janeiro-Brasil) for confirmation. If results were conflicting with these tests, western blot (Du Pont CO. Wilmington-USA) was performed to obtain a definitive result. Sixty-eight (22.1%) of all sera were positive. Although, the positivity in the homosexual group (26.2%) was more higher than in the bisexual group (18.3%). The positivity rate in both groups was directly proportional with the increase of age. Of course, people with less than 20 years old had only 3% of positivity, while between 20-29 had 18.1%, 30-39 had 34.5%, 40-49 had 40% and 50-59 had 50%. The projected curve of positivity, is progressive, that is to say, the risk of homo/bisexual males increases with age and is probably related to increased sexual activity. We conclude that more than one quarter of homosexual men are infected with HIV-1 in Belém.

Bacteriological evaluation of wounds in seriously burned hospitalized patients.

During the period between May and December 1988, 21 patients were studied bacteriologically at Hospital João XXIII's burn's unit which belongs to "Fundação Hospitalar do Estado de Minas Gerais" in Belo Horizonte, Brazil. A qualitative and quantitative evaluation of aerobic and facultative bacteria from burn wounds was carried out by the standard filter paper disc technique, including antibiotic susceptibility. At the same time an evaluation of those bacteria isolated from the environmental unit was performed. The most common organisms recovered from wounds of patients were: Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis. P. pseudomallei was the most frequent strain recovered from environmental specimens. In nearly all patients specimens (16 in total) from whom P. aeruginosa was isolated, the rate of CFU/cm2 of skin was above 10(2). In nine of these, it reached 10(5), which is equivalent to 10(7) CFU/g of burned tissue.

[Acute hemorrhagic conjunctivitis caused by a variant of coxsackievirus A24, in Belém, Pará, Brazil, 1987]. / Conjuntivite hemorrágica aguda causada pela variante do coxsackievirus A24, em Belém, Pará, Brazil, 1987.

An epidemic of acute haemorrhagic conjunctivitis in Belém, Pará, Brazil, was investigated. From 83 patients, 73 samples of virus was isolated in cultures of HEP-2 cells from conjunctival swab and throat swab. The virus isolates were identified in Centers for Disease Control, Atlanta, Georgia, USA, as an antigenic variant of coxsackievirus A24. Neutralization Test was done on 56 paired serum samples, using entero virus type 70 (EV70) and virus isolates. Serological conversions for virus isolates were found in 57% (32 patients).

Prevalencia de anticorpos para o virus da rubeola em uma comunidade indigena isolada, ao norte do Para,Brasil. / Prevalence of rubella virus antibodies in an indigenous isolated community, in the Northen Para State, Brazil

A prevalencia de anticorpos para o virus de rubeola, em marco de 1977, em 166 indios Tiriyos, foi de 38,5% sendo de 40,5% na populacao de masculinos e 36,9% na de femininos; em setembro do mesmo ano, foram colhidas amostras de soro de 168 silvicolas, dos quais 51,2% possuiam anticorpos para o citado virus; os homens com positividade de 51,3% e as mulheres com 51,1%. A incidencia de infecao pelo virus de rubeola, em 165 indios, dos quais se obtiveram soros pareados, no periodo compreendido entre os seis meses, foi de 12,1% entre os individuos do sexo feminino, na idade fertil, 14 a 40 anos, cerca de 11,1% foram infectados. Utilizou-se na deteccao de anticorpos especificos para rubeola, o metodo imunoenzimatico de ELISA