Families who previously refused organ donation would agree to donate in a new situation: a cross-sectional study.

BACKGROUND: The limited supply of organs restricts the number of transplantations. Studying the families who refuse donation may help to increase the number of transplantations. METHODS: This descriptive cross-sectional study used a questionnaire to obtain information from 61 family members who had refused to donate organs from January 1997 to December 2004. The exclusion criterion was donor death less than 1 year from the study. The mean age of subjects was 41 ± 12.7 years (range, 18 to 79 years) with 66% women. RESULTS: More than half (36 of 69; 52%) of the families who refused donation would agree to donate in a new situation. The primary reasons for refusing donation were: disagreement among family members (25 of 128; 19%), lack of knowledge regarding the deceased's wishes (22 of 128; 17%), and previous request from the deceased not to be a donor (17 of 128; 13%). The most frequent suggestions to increase organ donation were to provide families with more information (43 of 149; 29%), initiate contact among the families (36 of 149; 24%), and involve a trusted physician (30 of 149; 20%). CONCLUSION: Most family members who refused organ donation changed their minds and would agree to donate in a few situation. Most of the reasons for refusing to donate reflected a lack of information and discussion on the topic.

Quality of life, depression, and psychosocial characteristics of patients awaiting liver transplants.

BACKGROUND: The identification of the psychological issues that impair the quality of life and the adherence to treatment in transplant candidates are important. OBJECTIVE: This study evaluated the presence of symptoms of depression and the quality of life of liver transplant candidates. METHODS: One hundred liver transplant candidates underwent a psychological analysis using the following instruments: the short form-36 (SF-36) quality of life questionnaire, the Beck depression inventory (BDI), and Structured Interviews for liver transplant candidates. RESULTS: Seventy-three (73%) of the patients were males. Interestingly, 63% of the patients were in a domestic partnership. At the time of the evaluation, 55 patients were not working due to illness, 27 patients were actively working, and 11 patients were retired. Importantly, fears related to the transplant (e.g., fear the surgery and of death) were identified in 38% of the patients. The data from this study demonstrated a significant negative correlation between depressive scores (BDI) and seven of the eight areas of quality of life (SF-36), such as functional capacity (r = .317, P = .0013), social aspects (r = -.469, P < .0001), economic aspects (r = -.319, P = .0012), and mental health (r = -.3832, P < .0001). CONCLUSION: The data indicated that the psychological aspects related to transplants require psychological intervention because they can affect the recuperation process, the quality of life, and the adherence to treatment for potential transplant patients.

Excited state hydrogen transfer dynamics in substituted phenols and their complexes with ammonia: ππ*-πσ* energy gap propensity and ortho-substitution effect.

Lifetimes of the first electronic excited state (S(1)) of fluorine and methyl (o-, m-, and p-) substituted phenols and their complexes with one ammonia molecule have been measured for the 0(0) transition and for the intermolecular stretching σ(1) levels in complexes using picosecond pump-probe spectroscopy. Excitation energies to the S(1) (ππ*) and S(2) (πσ*) states are obtained by quantum chemical calculations at the MP2 and CC2 level using the aug-cc-pVDZ basis set for the ground-state and the S(1) optimized geometries. The observed lifetimes and the energy gaps between the ππ* and πσ* states show a good correlation, the lifetime being shorter for a smaller energy gap. This propensity suggests that the major dynamics in the excited state concerns an excited state hydrogen detachment or transfer (ESHD/T) promoted directly by a S(1)/S(2) conical intersection, rather than via internal conversion to the ground-state. A specific shortening of lifetime is found in the o-fluorophenol-ammonia complex and explained in terms of the vibronic coupling between the ππ* and πσ* states occurring through the out-of-plane distortion of the C-F bond.

Patients on the waiting list for liver transplantation: caregiver burden and stress.

Over the last few decades, informal caregivers of patients with chronic diseases have received more attention, and there is a growing volume of studies demonstrating high rates of burden, stress, and mental disorders in this group of individuals. The objective of this study was to evaluate the burden, stress, and psychosocial characteristics of informal caregivers of liver transplantation candidates. Participants were assessed by individual evaluations with the following instruments: a semistructured interview, the Caregiver Burden Scale, the Inventário de Sintomas de Stress para Adultos de Lipp, and the Beck Depression Inventory. The Mann-Whitney test was used for statistical analysis with a significance level of 0.05. The characteristics of the study group (n = 61) were similar to those of groups in other studies with respect to gender (82% were women), kinship (64% were spouses), and age (the mean age was 47.6 years). The main stressors identified by the participants were as follows: doubts about ways to react in a crisis or in emergency situations (42.6%), mood swings of the patient (29.5%), and care involving food and medications (27.9%). Approximately 25% of the caregivers reported that they felt unprepared to adequately perform their roles. Data analysis indicated a greater burden overall on caregivers when the patient's Model for End-Stage Liver Disease score was greater than or equal to 15 points (P = 0.041). Furthermore, caregivers of patients with alcoholic liver disease showed higher depression (P = 0.034) and overall burden scores (P = 0.031) versus caregivers of patients with liver disease due to other etiologies. In conclusion, the participants showed significantly high levels of burden, stress, and depression. Support measures and caregiver preparation should be implemented by health care providers.

Improvement in quality of life and self-esteem after breast reduction surgery.

BACKGROUND: Breast reduction surgery is sought by patients who have physical and psychological symptoms. This study assessed the quality of life and self-esteem before and after breast reduction surgery. METHODS: Thirty patients with a diagnosis of mammary hypertrophy who were consecutively selected to undergo breast reduction and aged between 18 and 54 years (mean = 32.65 years, SD = 9.87) participated in the study. Diagnosis was performed by breast measurements associated with symptoms related to excessive breast size. Patients completed the SF-36 Quality of Life Inventory and Rosenberg Self-Esteem Scale before the procedure and 30 and 120 days after surgery. The nonparametric sign test and Fisher's exact test were used to analyze the data. RESULTS: There was significant improvement (p < or = 0.05) in all domains of quality of life and in self-esteem when scores before and after surgery were compared. CONCLUSION: Both self-esteem and quality of life significantly improved after breast reduction surgery.

Patients undergoing liver transplantation: psychosocial characteristics, depressive symptoms, and quality of life.

BACKGROUND: Liver transplantation is the treatment of choice for patients with end-stage liver diseases to improve social rehabilitation and quality of life. Our objective was to evaluate the psychosocial characteristics, depressive symptoms, and quality of life among patients undergoing liver transplantation. MATERIALS AND METHODS: Patients underwent individual assessments using a semidirected interview. Beck's Depression Inventory and SF-36 Quality of Life Questionnaire. The signal test was used with a significance level set at .05. RESULTS: The characteristics of the sample (n = 30) were compatible with literature data for gender (n = 20 men), age (mean age, 51.96 years), education (elementary and middle school), and etiology (viral hepatitis). A significant number of patients were not able to maintain their professional activities: prior to transplantation (n = 18) and after transplantation (n = 13) due to the adverse effects of immunosuppressants (n = 9). The analysis indicated a significant quality of life improvement after transplantation for the following domains: functional capacity (P = .047), physical aspects (P = .024), pain (P = .001), overall health status (P = .003), and social aspects (P = .021). Significant depressive symptoms (n = 6) were experienced before and after the surgery. CONCLUSIONS: The data indicated a significant quality of life improvement after liver transplantation. Occupational activity and surgery time had a positive influence on these results. The frequency of depressive symptoms was similar before and after transplantation, correlating with less favorable quality of life scores. The results indicated the need to provide regular psychosocial assessment and follow-up in all stages of therapy.

[Epidemiological research on dementia in developing countries]. / Investigações epidemiológicas sobre demência nos países em desenvolvimento.

As the world population is ageing, dementia becomes an important public health problem, particularly in developing countries. Epidemiological research in these settings is scarce and present additional methodological difficulties, mainly regarding the socio-cultural adequacy of instruments used to identify cases of dementia. As a result of these concerns the 10/66 Dementia Research Group was founded to fill this gap. This is an international network of investigators, mostly from developing countries, and the group's name was based on the paradox that less than 10% of the population-based studies on dementia are directed to 2/3 or more cases of people with dementia living in developing countries. The aim of the paper is to update data in the literature regarding the differences in dementia prevalence and incidence seen in developed and developing countries.

Investigaçöes epidemiológicas sobre demência nos países em desenvolvimento / Epidemiological research on dementia in developing countries

Na medida em que a populaçäo mundial está envelhecendo, a demência está se constituindo em importante problema de saúde pública, particularmente nos países em desenvolvimento. Investigaçöes epidemiológicas nestes países säo escassas e apresentam dificuldades metodológicas adicionais, principalmente no que se refere à adequaçäo sociocultural dos instrumentos utilizados para a definiçäo de casos. Tendo em vista estas preocupaçöes, foi fundado o "Grupo de Pesquisa em Demência 10/66", que é constituído por uma rede internacional de pesquisadores, predominantemente de países em desenvolvimento. O nome do grupo tem como referência o paradoxo de que menos de 10 por cento dos estudos populacionais sobre demência säo dirigidos aos 2/3 ou mais de casos de pessoas com demência que vivem em países em desenvolvimento. O objetivo do artigo é atualizar informaçöes da literatura sobre as diferenças de prevalência e incidência de demência encontradas em países desenvolvidos e em desenvolvimento

Psicologia da saúde: extensão de serviços à comunidade, ensino e pesquisa / Health Psychology: Extended comunity services, education and research

O trabalho de psicólogos na área da saúde vem se desenvolvendo de forma crescente. O objetivo deste relato é descrever o desenvolvimento e estágio atual do Serviço de Psicologia do Hospital de Base da FAMERP, iniciado em 1981 com a contratação de uma psicóloga para atuar na enfermaria de Pediatria. Atualmente, o hospital conta com 40 psicólogos (docentes, contratados e aprimorandos) desenvolvendo atividades de extensão de serviços à comunidade, ensino e pesquisa em Psicologia da Saúde. A atuação abrange os níveis primário, secundário e terciário de atendimento e é realizada no ambulatório, no hospital, em Centro de Saúde Escola e na comunidade, principalmente em equipes interdisciplinares. O ensino envolve aulas para os cursos de graduação em medicina e enfermagem, estágio para alunos de psicologia, um Programa de Aprimoramento em Psicologia da Saúde, Cursos de Extensão, de Especialização e docência e orientação no Programa de Pós-Graduação em Ciências da Saúde (mestrado e doutorado) da FAMERP. As pesquisas visam principalmente o estudo das relações entre comportamento e saúde, abordando temas como promoção da saúde, prevenção e auxílio no tratamento e manejo de doenças. Embora a área esteja em expansão, é preciso pensar que a manutenção da credibilidade e do espaço conquistado dependem de uma sólida formação profissional, de um desempenho ético e do desenvolvimento de pesquisas na área(AU)

Psicologia da saúde: extensão de serviços à comunidade, ensino e pesquisa / Health Psychology: Extended comunity services, education and research

O trabalho de psicólogos na área da saúde vem se desenvolvendo de forma crescente. O objetivo deste relato é descrever o desenvolvimento e estágio atual do Serviço de Psicologia do Hospital de Base da FAMERP, iniciado em 1981 com a contratação de uma psicóloga para atuar na enfermaria de Pediatria. Atualmente, o hospital conta com 40 psicólogos (docentes, contratados e aprimorandos) desenvolvendo atividades de extensão de serviços à comunidade, ensino e pesquisa em Psicologia da Saúde. A atuação abrange os níveis primário, secundário e terciário de atendimento e é realizada no ambulatório, no hospital, em Centro de Saúde Escola e na comunidade, principalmente em equipes interdisciplinares. O ensino envolve aulas para os cursos de graduação em medicina e enfermagem, estágio para alunos de psicologia, um Programa de Aprimoramento em Psicologia da Saúde, Cursos de Extensão, de Especialização e docência e orientação no Programa de Pós-Graduação em Ciências da Saúde (mestrado e doutorado) da FAMERP. As pesquisas visam principalmente o estudo das relações entre comportamento e saúde, abordando temas como promoção da saúde, prevenção e auxílio no tratamento e manejo de doenças. Embora a área esteja em expansão, é preciso pensar que a manutenção da credibilidade e do espaço conquistado dependem de uma sólida formação profissional, de um desempenho ético e do desenvolvimento de pesquisas na área

Concomitant administration of sodium dichloroacetate and vitamin B1 for lactic acidemia in children with MELAS syndrome.

Myoclonic seizures, intractable abdominal pain, and headaches resolved during the concomitant administration of sodium dichloroacetate and vita min B1 in two Japanese siblings with the MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis and strokelike syndrome).

[Functional electric stimulation (FES) in cerebral palsy]. / Estimulação elétrica funcional (FES) na paralisia cerebral.

Our study concerns a patient with cerebral palsy, submitted to conventional occupational therapy and functional electrical stimulation. The results as to manual ability, spasticity, sensibility and synkinesis were satisfactory.