Validation of the Brazilian version of the VERITAS-Pro scale to assess adherence to prophylactic regimens in hemophilia.

INTRODUCTION: Prophylaxis is the treatment of choice for patients with severe hemophilia. Low adherence may limit the effectiveness of the prophylactic regimen, thereby compromising outcomes. OBJECTIVE: The objective of this study was to validate the Brazilian version of the VERITAS-Pro prophylaxis adherence scale, originally an American questionnaire that can be answered by the individual responsible for prophylaxis as well as by an observer. METHODS: The scale has 24 questions divided into six subscales: Routine, Dosage, Plan, Remember, Skip and Communicate. Participants were recruited at a blood center in southeastern Brazil for validation and reliability analyses. Validation measures included the results obtained using analog visual scales of adherence, interval between medication dispensed by the treatment center pharmacy and the percentage of recommended doses administered and infusions registered in the patients' logs. RESULTS: The study included 32 individuals responsible for prophylaxis and five observers. The internal consistency was very good for the VERITAS-Pro total score, excellent for the Remember, Skip and Communicate subscales, good for the Dosage subscale, and acceptable for the Routine and Plan subscales. Twelve participants answered the questionnaire on more than one occasion to evaluate reproducibility. The intraclass correlation coefficient was excellent. Regarding convergent validity, the VERITAS-Pro scores were moderately correlated with the global adherence scale and with infusion log records, but showed a weak correlation with pharmacy dispensation records. CONCLUSION: The Brazilian version of VERITAS-Pro is a valid and reliable instrument, enabling the understanding of specific factors related to non-adherence and allowing targeted interventions for proper treatment.

Validation of the Brazilian version of the VERITAS-Pro scale to assess adherence to prophylactic regimens in hemophilia

Abstract Introduction: Prophylaxis is the treatment of choice for patients with severe hemophilia. Low adherence may limit the effectiveness of the prophylactic regimen, thereby compromising outcomes. Objective: The objective of this study was to validate the Brazilian version of the VERITAS-Pro prophylaxis adherence scale, originally an American questionnaire that can be answered by the individual responsible for prophylaxis as well as by an observer. Methods: The scale has 24 questions divided into six subscales: Routine, Dosage, Plan, Remember, Skip and Communicate. Participants were recruited at a blood center in southeastern Brazil for validation and reliability analyses. Validation measures included the results obtained using analog visual scales of adherence, interval between medication dispensed by the treatment center pharmacy and the percentage of recommended doses administered and infusions registered in the patients' logs. Results: The study included 32 individuals responsible for prophylaxis and five observers. The internal consistency was very good for the VERITAS-Pro total score, excellent for the Remember, Skip and Communicate subscales, good for the Dosage subscale, and acceptable for the Routine and Plan subscales. Twelve participants answered the questionnaire on more than one occasion to evaluate reproducibility. The intraclass correlation coefficient was excellent. Regarding convergent validity, the VERITAS-Pro scores were moderately correlated with the global adherence scale and with infusion log records, but showed a weak correlation with pharmacy dispensation records. Conclusion: The Brazilian version of VERITAS-Pro is a valid and reliable instrument, enabling the understanding of specific factors related to non-adherence and allowing targeted interventions for proper treatment.

Hemophilia A in Brazil - epidemiology and treatment developments.

Hemophilia A is an inherited disorder characterized by deficiency of coagulation factor VIII, which predisposes patients to bleeding events. Treatment is based on replacement of the deficient factor, in a therapeutic or prophylactic manner. Brazil is the country with the third largest population of people with hemophilia, for which the public health system provides free comprehensive care. Maintaining an updated registry of patients, documenting the prevalence of complications, and assessing the effectiveness of resource use are indispensable elements in the design of a well-coordinated national program. According to sociodemographic, clinical, and laboratory data collected by the computerized Brazilian system on coagulopathies, in June 2013, there were 9,122 registered patients with hemophilia A in Brazil, of which 36.1% had a severe form of the disease. Clotting factor inhibitors were present in 7.5%, but 25.7% of records did not provide this type of data. Around 70% of the patients belonged to the economically active population, being between 15 and 59 years old. Infection by the human immunodeficiency virus was present in 23.4% of the patients tested and infection by hepatitis C virus antibodies in 59.3%. Infection by the hepatitis B virus and human T-lymphotropic virus was also reported. The high percentage of incomplete records regarding serological data shows the fragility of the information system to date. There was also no information available on the prevalence of permanent or disabling joint damage. Although few hemophiliacs receive adequate care in developing countries, and despite Brazil exhibiting great social inequalities, the Ministry of Health has made significant advances in the treatment of hemophilia A. The gradual increase in importation of factor VIII concentrate enabled the implementation of primary and secondary modalities of prophylaxis, in addition to the induction of immune tolerance. There are also plans to set up a factory in the country, to ensure Brazilian self-sufficiency in the production of blood products.

Health-related quality of life in hemophilia: results of the Hemophilia-Specific Quality of Life Index (Haem-a-Qol) at a Brazilian blood center.

BACKGROUND: Studies on health-related quality of life are based on the increasingly evident need for medical care not to be limited to preventing death, but to focus instead on the value of health. OBJECTIVE: This study aimed to measure the health-related quality of life in hemophilia, using the Hemophilia- Specific Quality of Life (Haem-A-QoL) questionnaire and describe the socioeconomic characteristics and health conditions of these patients. METHODS: The Brazilian version of the Hemophilia-Specific Quality of Life questionnaire was administered to hemophiliac adults, treated in an on-demand regime at the Juiz de Fora Regional Blood Center - HEMOMINAS Foundation. The patients were interviewed about demographic and socioeconomic data and their understanding of the questionnaire. Clinical data were collected from medical records. The Mann-Whitney U test was used for statistical analysis. The level of significance was set for p-values < 0.05. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, version 15.0). RESULTS: Thirty-nine patients were evaluated. The mean age was 36.8 years. 84.6% had hemophilia A; 20.5% of the patients had hemophilia classified as mild, 41% as moderate and 38.5% as severe. The records of 10.5% of the patients registered seropositivity for anti-HIV and 57.9% for anti-HCV. Target joints were detected in 69.2%. The mean total Hemophilia-Specific Quality of Life score was 35.55. 'Sports and leisure'and 'Physical health'were the most impaired dimensions and the dimension 'Relationship and partners'was the least impaired. The Hemophilia-Specific Quality of Life scores showed good discriminant validity for hemophilia severity (p-value = 0.001), HIV-infection (p-value = 0.02), HCV-infection (p-value = 0.01) and the presence of target joints (p-value < 0.001). CONCLUSION: Health-related quality of life in hemophilia, measured by the Hemophilia-Specific Quality of Life questionnaire, was influenced by the presence of arthropathy and infectious diseases transmitted by blood products. Rehabilitation measures should be encouraged in order to improve the quality of life of these patients.

Clinical and functional evaluation of the joint status of hemophiliac adults at a Brazilian blood center.

BACKGROUND: Hemophilia is a potentially disabling condition as hemophilic arthropathy develops early in life and is progressive, especially in patients treated in an on-demand regime. OBJECTIVE: This study aimed to describe the structural joint status and the functional independence score of hemophiliac adults and correlate structural damage with the functional deficits found in these patients. METHODS: Hemophiliacs at the Juiz de Fora Regional Blood Center - HEMOMINAS Foundation, aged 18 years and over and treated in an on-demand regime, were clinically evaluated in respect to structural joint damage using the World Federation of Hemophilia Physical Examination Scale (WFH-PE) and functional deficits using the Functional Independence Score in Hemophilia (FISH). The Spearman rank test was used to evaluate the correlation between the two scores. RESULTS: Thirty-nine patients were evaluated. The mean age was 36.8 years. Target joints were detected in 69.2% of patients studied. The mean Physical Examination Scale and Functional Independence Score were 16.87 and 25.64, respectively. Patients with mild hemophilia showed no significant joint involvement. Patients with severe or moderate hemophilia had similar results regarding structural damage (p-value < 0.001) and functional deficits (p-value = 0.001). There was statistical significance in the correlation between the two scores (r = -0.850; p-value = 0.01). CONCLUSIONS: The World Federation of Hemophilia Physical Examination Scale and Functional Independence Score in Hemophilia may be useful to clinically assess structural joint damage and functional deficits in hemophiliacs as the tools are inexpensive and easy to administer and may be able to detect hemophilic arthropathy, which results from recurrent hemarthrosis and is common in the population studied.

Health-related quality of life in hemophilia: results of the Hemophilia-Specific Quality of Life Index (Haem-a-Qol) at a Brazilian blood center

BACKGROUND Studies on health-related quality of life are based on the increasingly evident need for medical care not to be limited to preventing death, but to focus instead on the value of health. OBJECTIVE This study aimed to measure the health-related quality of life in hemophilia, using the Hemophilia- Specific Quality of Life (Haem-A-QoL) questionnaire and describe the socioeconomic characteristics and health conditions of these patients. METHODS The Brazilian version of the Hemophilia-Specific Quality of Life questionnaire was administered to hemophiliac adults, treated in an on-demand regime at the Juiz de Fora Regional Blood Center - HEMOMINAS Foundation. The patients were interviewed about demographic and socioeconomic data and their understanding of the questionnaire. Clinical data were collected from medical records. The Mann-Whitney U test was used for statistical analysis. The level of significance was set for p-values < 0.05. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, version 15.0). RESULTS Thirty-nine patients were evaluated. The mean age was 36.8 years. 84.6% had hemophilia A; 20.5% of the patients had hemophilia classified as mild, 41% as moderate and 38.5% as severe. The records of 10.5% of the patients registered seropositivity for anti-HIV and 57.9% for anti-HCV. Target joints were detected in 69.2%. The mean total Hemophilia-Specific Quality of Life score was 35.55. 'Sports and leisure'and 'Physical health'were the most impaired dimensions and the dimension 'Relationship and partners'was the least impaired. The Hemophilia-Specific Quality of Life scores showed good discriminant validity for hemophilia severity (p-value = 0.001), HIV-infection (p-value = 0.02), HCV-infection (p-value = 0.01) and the presence of target joints (p-value < 0.001)...

Clinical and functional evaluation of the joint status of hemophiliac adults at a Brazilian blood center

BACKGROUND: Hemophilia is a potentially disabling condition as hemophilic arthropathy develops early in life and is progressive, especially in patients treated in an on-demand regime. Objective: This study aimed to describe the structural joint status and the functional independence score of hemophiliac adults and correlate structural damage with the functional deficits found in these patients. METHODS: Hemophiliacs at the Juiz de Fora Regional Blood Center - HEMOMINAS Foundation, aged 18 years and over and treated in an on-demand regime, were clinically evaluated in respect to structural joint damage using the World Federation of Hemophilia Physical Examination Scale (WFH-PE) and functional deficits using the Functional Independence Score in Hemophilia (FISH). The Spearman rank test was used to evaluate the correlation between the two scores. RESULTS: Thirty-nine patients were evaluated. The mean age was 36.8 years. Target joints were detected in 69.2% of patients studied. The mean Physical Examination Scale and Functional Independence Score were 16.87 and 25.64, respectively. Patients with mild hemophilia showed no significant joint involvement. Patients with severe or moderate hemophilia had similar results regarding structural damage (p-value < 0.001) and functional deficits (p-value = 0.001). There was statistical significance in the correlation between the two scores (r = -0.850; p-value = 0.01). CONCLUSIONS: The World Federation of Hemophilia Physical Examination Scale and Functional Independence Score in Hemophilia may be useful to clinically assess structural joint damage and functional deficits in hemophiliacs as the tools are inexpensive and easy to administer and may be able to detect hemophilic arthropathy, which results from recurrent hemarthrosis and is common in the population studied.

Criatividade e inteligência: analisando semelhanças e discrepâncias no desenvolvimento / Creativity and intelligence: analyzing developmental similarities and discrepancies

As semelhanças e discrepâncias entre inteligência e criatividade foram investigadas, assim como os possíveis impactos de gênero e série educacional sobre o seu desenvolvimento. A amostra foi composta por 172 estudantes (91 mulheres, 81 homens), com idades variando dos 7 aos 17 anos. A avaliação da inteligência foi feita por meio da versão brasileira da Bateria Woodcock-Johnson III enquanto que criatividade foi avaliada pelos Testes de Pensamento Criativo de Torrance. Os resultados obtidos pelas MANOVA e ANOVA demonstraram efeitos significativos de série escolar para inteligência e criatividade figural, e de sexo para criatividade verbal. Não houve correlações significativas entre inteligência e criatividade, de acordo com as medianas nos testes de inteligência. A análise fatorial rotação Varimax apontou distinção entre inteligência, criatividade verbal e figurativa, indicando a independência entre estes construtos.(AU)

The similarities and discrepancies between intelligence and creativity were investigated as well as the impact of gender and educational level upon their development. The sample was composed of 172 students (91 women, 81 man), ages ranging from 7-17 years old. Intelligence was assessed through the Brazilian version of the Woodcock-Johnson III tests, whereas creativity was evaluated through the Torrance tests of creativity. Results analyzed by MANOVA and ANOVA indicated significant effects of educational grade upon intelligence and creativity, and sex effects only on verbal creativity. No significant correlations were found between intelligence and creativity according to median results on intelligence tests. Factor analysis demonstrated the distinction among intelligence, verbal and figural creativity. On conclusion, creativity and intelligence were found as being independent constructs.(AU)

Leucemias agudas: primeiros sinais e sintomas em pacientes menores de 20 Anos no Hospital Universitário de Juiz de Fora / Universidade Federal de Juiz de Fora Medical research: how to improve students´ involvement

As leucemias agudas são as causas de câncer mais comuns na infância e seus sinais e sintomas, na maioria dos casos , são inespecíficos no inicío da doença; o que retarda o diagnóstico e consequentemente o tratamento. Este Trabalho visa analisar os prontuários de pacientes com diagnósticos e assim alertar os profissionais de saúde para que estes façam o diagnóstico mais alertar os profissionais da saúde para que estes façam o diagnóstico mais proprecocemente. Dentre os achados mais frequentes encontram-se: palidez (96,4%); febre (82,14%); hepatomegalia (75%); esplenomegalia (71,4%); linfadenomegalia (53,6%); anemia (92,9%); leucocitose (64,3); neutropenia (46,4%);trombocitopenia (88,5%) e blastos (71,43%).

Produção científica sobre o idoso no psycInfo(2003)

Com o aumento da longevidade e conseqüente aumento da produção cientifica sobre velhice, faz-se necessária uma análise do conhecimento gerado na área. Foi feita uma meta-análise dos estudos realizados na área de psicologia sobre idosos, inseridos na base de dados PsyclNFO, no primeiro semestre de 2003 (N=1281). Foram analisados: título, autoria, tipo de trabalho, temática, participantes, locais de realização das pesquisas, materiais usados para a coleta de dados e enfoque. No geral, os títulos apresentaram número de vocábulos dentro do recomendado, sendo que em 42,89 por cento não foi feito uso de pontuação e em 34,76 por cento foi utilizado dois pontos. A autoria foi predominantemente múltipla (90,1 por cento), com maior produção masculina. A produção de pesquisas é predominante (98,75 por cento), sendo o periódico cientifico o veículo mais utilizado para divulgação (98,4 por cento). Os temas mais freqüentes foram Aspectos Sociais/ Culturais, Aspectos/Características Psicológicas e Doenças; houve correlação entre a classificação feita pela base e pelos autores (r=0,98). A maioria dos estudos compara idosos e pessoas adultas. América e Europa foram os continentes de maior produção. A maioria dos trabalhos foi realizada em Serviços de Saúde (37,71 por cento), tendo sido usados vários tipos de instrumentos para a coleta dos dados. A diferença entre o enfoque perda (21 por cento) e ganho (13,82 por cento) foi estatisticamente significante. Conclui-se que a área mostra sinais de desenvolvimento (AU)

Doença de Behçet: relato de caso / Behçet's disease: a case report

A doença de Behçet é uma afecção multissistêmica com alterações mucocutâneas, oculares, urogenitais, vasculares, articulares e neurológicas. Os autores apresentam o caso de uma mulher de 33 anos, com história de turvação visual e úlceras orais e genitais recorrentes que requereu internação hospitalar pelo acometimento do estado geral. Após exame oftalmológico, fez-se o diagnóstico de doença de Behçet, iniciando-se tratamento com remissão completa das úlceras e melhora das alterações oculares e do estado geral. O objetivo do artigo é alertar para a importância do diagnóstico e tratamento precoces dessa doença para evitar sequelas como a cegueira.

Behcet's disease is recognized as a multisystemic disorder, featuring mucocutaneous, ocular, urogenital, vascular, articular and neurologic envolvement. The authors present the case of 33-years-old woman with visual blurring and recurrent oral and genital ulcers, requering admission due to general impairment. The diagnosis of Behçet's disease followed an ophtalmic examination, with treatment bringing about complete remission of the ulcers and improvement of both ocular involvement and general symptons. The purpose of this article is to warn for the importance of an early diagnosis and treatment to avoid sequelaes, as blindness.