Uso de misoprostol em obstetrícia / Misoprostol use in obstetrics

PONTOS-CHAVE O misoprostol é um análogo da prostaglandina E1 (PGE1) que consta na Lista de Medicamentos Essenciais da Organização Mundial da Saúde (OMS) desde 2005 O Brasil possui uma das regulações mais restritivas do mundo relacionadas ao uso do misoprostol, estabelecendo que o misoprostol tem uso hospitalar exclusivo, com controle especial, e venda, compra e propaganda proibidas por lei Atualmente, o misoprostol é a droga de referência para tratamento medicamentoso nos casos de aborto induzido, tanto no primeiro trimestre gestacional quanto em idades gestacionais mais avançadas O misoprostol é uma medicação efetiva para o preparo cervical e indução do parto O misoprostol é um medicamento essencial para o manejo da hemorragia pós-parto

Bottom-up advocacy strategies to abortion access during the COVID-19 pandemic: Lessons learned towards reproductive justice in Brazil.

In Brazil, abortion is only allowed in cases of rape, serious risk to a woman's life or fetal anecephaly. Legal abortion services cover less than 4% of the Brazilian territory and only 1,800 procedures are performed, in average, per year. During the COVID-19 pandemic, almost half of the already few Brazilian abortion clinics shut down and women had to travel even longer distances, reaching abortion services at later gestational ages. In this paper, we describe three bottom-up advocacy strategies that emerged from difficulties deepened during the COVID-19 pandemic at a single abortion service in Brazil, amidst anti-gender policies from the federal government. Telemedicine abortion, outpatient surgical abortion and the provision of abortion after 20 weeks' gestation are important strategies that may reduce inequalities that impact the most vulnerable populations, such as black and indigenous women, children, adolescents and women experiencing domestic violence.

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.

Boosting nonverbal physician-patient communication in medical education / Impulsionando a comunicação não verbal na educação médica

Abstract: Introduction: Nonverbal communication is an important part of the medical interview. However, nonverbal skills are still underestimated in medical education and instruments for their teaching and assessing in medical schools are scarce. Objective: We aimed to translate and culturally adapt the Relational Communication Scale for Observational measurement of doctor-patient interactions (RCS-O) to Brazilian Portuguese. Methods: We translated the RCS-O in seven stages: initial translation, reconciliation, back translation, review by the author, independent review, consensus version through the Delphi technique, review by a language coordinator, and pre-test. We used video recordings of four medical consultations performed by medical students and residents to pre-test the instrument. During this phase, three independent observers assessed the medical students and residents' performance in real health care scenarios through the use of the recordings. Results: Most of the difficulties regarding the translation and cultural adaptation were related to the polysemic meaning of some items. Words and expressions such as "stimulating", "warmth", "desire", "relaxed", "conversation to a deeper level", "deeper relationship", "casual", and "intensely" required adaptation in order to remove the potential sexual connotation that could arise from overintimacy in the physician-patient relationship. Conclusion: The Brazilian version of the RCS-O is a culturally, conceptually, semantically and operationally valid instrument. It may represent an important advance for the strengthening of learning and assessing nonverbal communication in medical education. We hope this study may encourage health educators to invest in the teaching and assessment of nonverbal communication skills in other countries.

Resumo: Introdução: A comunicação não verbal corresponde a importante parte da entrevista médica. No entanto, as habilidades não verbais ainda são subestimadas na educação, e os instrumentos para ensino e avaliação nas escolas de saúde são escassos. Objetivo: Nosso objetivo foi traduzir e adaptar culturalmente a Relational Communication Scale for Observational measurement of doctor-patient interactions (RCS-O) para o português do Brasil. Método: Traduzimos a RCS-O em sete etapas: tradução inicial, reconciliação, retrotradução, revisão pelo autor, revisão independente, consenso pela técnica Delphi, revisão por um coordenador de linguagem e pré-teste. Utilizamos gravações de quatro consultas médicas realizadas por estudantes de Medicina e residentes para pré-testar o instrumento. Durante essa fase, três observadores independentes avaliaram o desempenho de estudantes de Medicina e residentes em cenários reais de assistência médica por meio do uso das gravações. Resultados: A maioria das dificuldades de tradução e adaptação cultural foi relacionada ao significado polissêmico de alguns itens. Palavras e expressões como "stimulating", "warmth", "desire", "relaxed", "conversation to a deeper level", "deeper relationship", "casual", and "intensely" precisaram ser adaptadas para remover a conotação sexual que poderia surgir da intimidade presente na relação médico-paciente. Conclusão: A versão brasileira da RCS-O é cultural, conceitual, semântica e operacionalmente válida. Representa um avanço importante para o ensino e a avaliação da comunicação não verbal na educação médica. Esperamos que este estudo possa incentivar educadores de saúde a investir no ensino e na avaliação dessas habilidades nas escolas médicas.

Contraceptive counseling lectures do not influence decision making in family planning services.

Family planning services should provide women and men with information on contraceptive methods. This study aimed to evaluate the impact of multidisciplinary contraceptive counseling lectures related to the efficacy and individual choices of contraceptive methods. Sociodemographic variables, preferred methods and opinion about the efficacy of contraceptive methods of 101 participants were analyzed. After the lecture, a lower percentage of men declared that they did not know which contraceptive method was more efficacious (24.3% versus 0.0%; p=0.006). Also, a lower percentage of women (12.7% versus 1.8%; p=0.020) and men (25.5% versus 7.7%; p=0.003) reported that they did not know which contraceptive method was less efficacious. Number of children increased the likelihood of choosing an irreversible method in a 30.87-fold (95%CI, 5.503 to 173.168, p<0.001). The choice of irreversible methods did not change after the counseling lecture (p>0.05). The lecture impacted on participants' opinions about the efficacy of contraceptive methods, making them have more informed choices. However, it did not influence their choice of contraception. Number of children was the most determining factor in choosing irreversible methods.

Innovations in Curriculum Designs Do Not Guarantee Students' Patient-Centered Attitudes Running Title: Curricula and Patient-Centered Attitudes / Inovações no Desenho Curricular não Garantem Atitudes Centradas no Paciente entre os Estudantes

ABSTRACT Background Medical schools all around the world are engaged in curricular reforms aimed at fostering patient- and learner-centeredness, implementing curricular transformations in order to counterbalance the erosion of humanistic and professional values and the loss of idealism of recent graduate physicians. In Brazil, medical schools are facing the challenge of redesigning medical curricula towards more learner-centered and patient-centered approaches, stimulated by recent national medical education guidelines. However, desirable outcomes towards medical education have not been fully achieved. Aim To access medical students' attitudes and determine predictors of medical students' patient-centered attitudes among students from different curricular designs (traditional, innovative and advanced). Methods Medical students from 1st to 6th year from 21 Brazilian medical schools participating in the project for evaluating change and trends proposed by the Brazilian Association of Medical Education, with different stages of curricular designs (traditional, innovative and advanced), answered the Brazilian version of the Patient-Practitioner Orientation Scale (B-PPOS) and a questionnaire with curricular and sociodemographic variables. Results Brazilian medical students care more than they share information, power and responsibility (p < 0.001; d = 0.599). They are more concerned with the psychosocial context than with patient's perspective (p < 0.001; d = 0.797) and share more power and responsibility than understanding (p < 0.001, d = 0.455). Female gender (B = 0.180), students from public schools (B = 0.132), year of medical training (B = 0.021), preference for future medical practice in public services (B = 0.053) and extracurricular activities (B = 0.068) were predictors of patient-centered attitudes among medical students (p < 0.05). Meanwhile, the father's educational level and choice to study surgical specialties (p < 0.05) were predictors of less patient-centered attitudes among students. Different curricular designs were not associated with students' patient-centered attitudes (p > 0.05). Conclusion tant predictors of patient-centered attitudes among medical students. Further research should investigate the direct influence of faculty professionalism development programs on students' patient centered-attitudes.

Introdução Escolas médicas de todo o mundo estão engajadas em reformas curriculares com o objetivo de melhorar a centralidade do ensino no paciente e no aluno, implementando transformações curriculares a fim de contrabalançar a erosão dos valores humanísticos e profissionais, bem como a perda do idealismo de médicos recém-formados. Escolas médicas brasileiras encaram o desafio de redesenhar os currículos médicos em direção a abordagens mais centradas no paciente e no aluno, estimuladas pelas recentes diretrizes curriculares nacionais dos cursos de Medicina. Entretanto, os resultados desejados não têm sido totalmente alcançados. Objetivo Acessar as atitudes dos estudantes de Medicina e determinar preditores das atitudes mais centradas no paciente entre os estudantes de Medicina de diferentes desenhos de currículo (tradicional, inovador e avançado). Método Estudantes de Medicina do primeiro ao sexto ano de 21 escolas médicas brasileiras que participaram do projeto de avaliação de tendências de mudanças no curso de graduação nas escolas médicas brasileiras proposta pela Associação Brasileira de Educação Médica, com diferentes estágios de currículo (tradicional, inovador e avançado), responderam à versão brasileira da Escala de Orientação Médico-Paciente (EOMP) e a um questionário com variáveis sociodemográficas e curriculares. Resultados Estudantes de Medicina brasileiros cuidam mais do que compartilham informação, poder e responsabilidade (p < 0.001; d = 0.599). Cuidam mais do contexto psicossocial do que da perspectiva do paciente (p < 0.001; d = 0.797) e compartilham mais poder e responsabilidade do que entendimento (p < 0.001, d = 0.455). Gênero feminino (B = 0.180), estudantes de escolas médicas públicas (B = 0.132), ano de treinamento médico (B = 0.021), preferência por futura prática em serviços públicos (B = 0.053) e atividades extracurriculares (B = 0.068) foram preditores de atitudes mais centradas no paciente entre os estudantes de Medicina (p < 0.05). Diferentes desenhos curriculares não foram associados com atitudes mais centradas no paciente (p > 0.05). Conclusões Desenhos curriculares não predizem atitudes dos estudantes de Medicina. Ser mulher e frequentar uma escola médica pública foram importantes preditores de atitudes mais centradas no paciente entre os estudantes de Medicina.

Quality of life and burnout among faculty members: How much does the field of knowledge matter?

BACKGROUND: Faculty members face demands such as research, outreach programs, and management activities. Such demands may expose faculty to burnout. Burnout affects the physical, psychological and social health of faculty members, but it is still unclear how it affects their quality of life. We aimed to assess the impact of burnout on the quality of life (QoL) of faculty members from different fields of knowledge. METHODS: Cross-sectional study using validated tools for measuring burnout and QoL (Oldenburg Burnout Inventory-OLBI and World Health Organization Quality of Life-Abbreviated version-WHOQOL-Bref) in a sample of 366 faculty members from a public university. Scores were analyzed using Student's t-test, analysis of variance (ANOVA), binary logistic regression, and structural equation modeling (SEM). RESULTS: More than a third of the faculty members (n = 127; 36.6%) suffered from burnout. Men had higher scores of quality of life than women in the physical health (p = 0.001; d<0.5), psychological (p = 0.001; d<0.5) and social relationships (p = 0.048; d<0.5) domains. Women were more exhausted than men (p = 0.001; d<0.5). Faculty members' perception of quality of life and burnout did not differ according to their field of knowledge (p>0.05). Participants who felt tired before arriving at work were less likely to report good quality of life (OR = 0.46; 95% CI = 0.21-0.99). Faculty members who stated they needed more time to relax after work were less likely to be satisfied with their health (OR = 0.20; 95% CI = 0.10-0.40). Burnout showed a negative association with quality of life (λ = 0.87; p < 0,001; df = 8). CONCLUSIONS: Burnout negatively affects faculty members' quality of life, regardless of their field of knowledge. Our results suggest the implementation of programs and actions to prevent burnout to faculty members, especially to women, as their quality of life may affect the quality of the education provided.

Translation and cultural adaptation of the Pediatric Eosinophilic Esophagitis Symptom Score (PEESS v2 0) / Tradução e adaptação cultural da Pediatric Eosinophilic Esophagitis Symptom Score (PEESS v2 0)

Abstract Objectives: To translate and culturally adapt the Pediatric Eosinophilic Esophagitis Symptom Score (version 2.0), a tool used to assess pediatric eosinophilic esophagitis symptoms reported by patients and/or their parents/caregivers. Methods: The Pediatric Eosinophilic Esophagitis Symptom Score was translated through the following stages: initial translation, back-translation, and consensus of independent reviewers through the Delphi technique. The pre-final version of the Pediatric Eosinophilic Esophagitis Symptom Score was applied to five 8-to-18-year-old patients and to ten parents of two-to-18-year-old patients from an outpatient pediatric gastroenterology service (pre-test). Results: During the translation process, no translations presenting with difficult consensus in the review process or grammar inconsistencies were observed. During the pre-test, difficulties in comprehension of some unconventional terms, e.g., "náusea", were observed. Adverbs of frequency, such as "quase nunca" were also identified as being of difficult understanding by patients and parents, and the substitution by the term "raramente" was suggested. Such difficulties may be inherent to the pediatric age group. Age 8 years or above should be considered adequate for the self-reporting of symptoms. Conclusions: The study presents the Brazilian version of the Pediatric Eosinophilic Esophagitis Symptom Score, which is adapted to the Brazilian culture. This version may be introduced as a clinical and research tool for the assessment of patients with esophagic disease symptoms. The Pediatric Eosinophilic Esophagitis Symptom Score is a breakthrough in the evaluation of symptoms of pediatric eosinophilic esophagitis, since it reinforces the importance of self-reporting by patients who experience this disease.

Resumo Objetivo: Traduzir e adaptar culturalmente a Pediatric Eosinophilic Esophagitis Symptom Score (versão 2.0), um instrumento usado para identificar os sintomas relatados pelos pacientes ou seus pais/responsáveis para a avaliação da esofagite eosinofílica pediátrica. Método: Realizamos o processo de tradução a partir da tradução inicial, retrotradução, seguida da etapa de obtenção de consenso por revisores independentes por meio da técnica Delphi. Aplicamos a versão pré-final a cinco pacientes de 8 a 18 anos e dez pais de pacientes de 2 a 18 anos no Serviço de Gastroenterologia Pediátrica (pré-teste). Resultados: No processo de tradução, não encontramos traduções de difícil consenso no processo de revisão ou discordâncias gramaticais. No pré-teste, identificamos dificuldades de entendimento de termos pouco convencionais, como "náusea", com sugestão de substituição para o termo "enjoo". Outra dificuldade encontrada relacionou-se aos advérbios de frequência da escala, como, por exemplo, "quase nunca", foi sugerida a substituição pelo termo "raramente". Essas dificuldades podem ser inerentes à faixa etária pediátrica. A idade dos pacientes a partir de oito anos deve ser considerada adequada para o uso de escores de autorrelato. Conclusões: A tradução do escore de sintomas da esofagite eosinofílica pediátrica produziu uma escala adaptada à cultura brasileira, que poderá ser introduzida como instrumento de investigação clínica e de pesquisa em pacientes com sintomas sugestivos de doenças esofágicas. É um importante avanço na avaliação dos sintomas, já que valoriza o relato dos próprios pacientes que convivem com essa doença.

Cross-cultural adaptation of the Four Habits Coding Scheme (4HCS) for teaching and assessing patient-centered communication skills in Brazil.

Brazilian educational guidelines reinforce patient-centered care communication skills as an important competence for medical students. The Four Habits Coding Scheme (4HCS) is an instrument used for teaching and assessing clinicians' communication skills in a person-centered care approach. We aimed to translate and culturally adapt the 4HCS into Brazilian Portuguese. The translation process was accomplished in seven stages: initial translation, reconciliation, back translation, review by the author, independent review, consensus version through Delphi technique, review by a language coordinator, and pretest. During pretest, three independent observers assessed four medical consultations, which were performed by medical students and residents, that had been recorded in a real healthcare scenario. Reviewers had difficulty in reaching consensus on expressions referring to understanding the person as a whole, such as "Engage in small talk", "Expansion of concerns", "Elicit full agenda", "Use patient's frame of reference", and "Explore plan acceptability". They also had difficulty in reaching consensus on the translation of the word "clinician", which was first translated as "physician". Historical and cultural issues in the physician-patient relationship may have influenced this result. The Brazilian 4HCS is a culturally, conceptually, semantically and operationally sound instrument. It may represent an important advance for strengthening the person-centered care model in Brazil.

Translation and cultural adaptation of the Pediatric Eosinophilic Esophagitis Symptom Score (PEESS v2.0).

OBJECTIVES: To translate and culturally adapt the Pediatric Eosinophilic Esophagitis Symptom Score (version 2.0), a tool used to assess pediatric eosinophilic esophagitis symptoms reported by patients and/or their parents/caregivers. METHODS: The Pediatric Eosinophilic Esophagitis Symptom Score was translated through the following stages: initial translation, back-translation, and consensus of independent reviewers through the Delphi technique. The pre-final version of the Pediatric Eosinophilic Esophagitis Symptom Score was applied to five 8-to-18-year-old patients and to ten parents of two-to-18-year-old patients from an outpatient pediatric gastroenterology service (pre-test). RESULTS: During the translation process, no translations presenting with difficult consensus in the review process or grammar inconsistencies were observed. During the pre-test, difficulties in comprehension of some unconventional terms, e.g., "náusea", were observed. Adverbs of frequency, such as "quase nunca" were also identified as being of difficult understanding by patients and parents, and the substitution by the term "raramente" was suggested. Such difficulties may be inherent to the pediatric age group. Age 8 years or above should be considered adequate for the self-reporting of symptoms. CONCLUSIONS: The study presents the Brazilian version of the Pediatric Eosinophilic Esophagitis Symptom Score, which is adapted to the Brazilian culture. This version may be introduced as a clinical and research tool for the assessment of patients with esophagic disease symptoms. The Pediatric Eosinophilic Esophagitis Symptom Score is a breakthrough in the evaluation of symptoms of pediatric eosinophilic esophagitis, since it reinforces the importance of self-reporting by patients who experience this disease.

Cross-cultural adaptation of the Four Habits Coding Scheme (4HCS) for teaching and assessing patient-centered communication skills in Brazil / Adaptação transcultural do Four Habits Coding Scheme (4HCS) para o ensino e avaliação de habilidades de comunicação centradas no paciente no Brasil / Adaptación transcultural del Four Habits Coding Scheme (4HCS) para la enseñanza y evaluación de habilidades de comunicación centradas en el paciente en Brasil

Abstract: Brazilian educational guidelines reinforce patient-centered care communication skills as an important competence for medical students. The Four Habits Coding Scheme (4HCS) is an instrument used for teaching and assessing clinicians' communication skills in a person-centered care approach. We aimed to translate and culturally adapt the 4HCS into Brazilian Portuguese. The translation process was accomplished in seven stages: initial translation, reconciliation, back translation, review by the author, independent review, consensus version through Delphi technique, review by a language coordinator, and pretest. During pretest, three independent observers assessed four medical consultations, which were performed by medical students and residents, that had been recorded in a real healthcare scenario. Reviewers had difficulty in reaching consensus on expressions referring to understanding the person as a whole, such as "Engage in small talk", "Expansion of concerns", "Elicit full agenda", "Use patient's frame of reference", and "Explore plan acceptability". They also had difficulty in reaching consensus on the translation of the word "clinician", which was first translated as "physician". Historical and cultural issues in the physician-patient relationship may have influenced this result. The Brazilian 4HCS is a culturally, conceptually, semantically and operationally sound instrument. It may represent an important advance for strengthening the person-centered care model in Brazil.

Resumo: As diretrizes brasileiras para a educação enfatizam as habilidades de comunicação centradas no paciente enquanto importante competência para os estudantes de medicina. O Four Habits Coding Scheme (4HCS) é um instrumento utilizado no ensino e avaliação das habilidades de comunicação do clínico em uma abordagem de cuidado centrado na pessoa. O nosso objetivo foi traduzir e realizar a adaptação transcultural do 4HCS para o português do Brasil. O processo de tradução foi realizado em sete estágios: tradução independente, reconciliação, retro-tradução, revisão pelo autor, revisão independente - consenso através da técnica Delphi -, revisão por um coordenador linguístico e pré-teste. Durante o pré-teste, três observadores independentes avaliaram quatro consultas médicas realizadas por estudantes e residentes de medicina que foram gravadas em um cenário de atendimento real. Os revisores tiveram dificuldade em chegar a um consenso sobre expressões referentes à compreensão da pessoa como um todo, tais como "engage in small talk", "expansion of concerns", "elicit full agenda", "use patient's frame of reference" e "explore plan acceptability". Também tiveram dificuldade em chegar a um consenso sobre a tradução da palavra "clinician", que fora traduzida primeiro como "médico". Questões históricas e culturais na relação médico-paciente podem ter influenciado o resultado. A versão brasileira do 4HCS é um instrumento válido no sentido cultural, conceitual, semântico e operacional. Pode representar um avanço importante no fortalecimento do modelo de cuidado centrado no paciente no Brasil.

Resumen: Las directrices brasileñas para la educación enfatizan las habilidades de comunicación centradas al paciente, por considerarla una importante competencia para los estudiantes de medicina. El Four Habits Coding Scheme (4HCS) es un instrumento utilizado en la enseñanza y evaluación de las habilidades de comunicación dentro del ámbito clínico, desde una perspectiva de cuidado centrado en la persona. El objetivo fue traducir y realizar la adaptación transcultural del 4HCS al portugués de Brasil. El proceso de traducción se realizó en siete fases: traducción independiente, conciliación, retro-traducción, revisión por parte del autor, revisión independiente -consenso a través de la técnica Delphi-, revisión por parte de un coordinador lingüístico y prueba previa. Durante la prueba previa, tres observadores independientes evaluaron cuatro consultas médicas, que fueron realizadas por estudiantes y residentes de medicina que se grabaron en un escenario de atención real. Los revisores tuvieron dificultades para llegar a un consenso sobre expresiones referidas a la comprensión de la persona como un todo, tales como "engage in small talk", "expansion of concerns", "elicit full agenda", "use patient's frame of reference" y "explore plan acceptability". También tuvieron dificultades para llegar a un consenso sobre la traducción de la palabra "clinician", que se tradujo en primera instancia como "médico". Las cuestiones históricas y culturales en la relación médico-paciente pueden haber influenciado el resultado. La versión brasileña del 4HCS es un instrumento válido, en el sentido cultural, conceptual, semántico y operacional. Puede representar un avance importante en el fortalecimiento del modelo de cuidado centrado en el paciente en Brasil.

Parents' perception of health-related quality of life in children and adolescents with excess weight / Percepção dos pais acerca da qualidade de vida relacionada à saúde de crianças e adolescentes com excesso de peso

ABSTRACT OBJECTIVE: To evaluate the perception of parents or caregivers on the health-related quality of life (HRQOL) of children/adolescents with overweight/obesity and possible factors associated with this perception. METHODS: This was a cross-sectional study involving 297 caregivers of children and adolescents with normal weight (n = 170) and with overweight/obesity (n = 127), from public and private schools in the study municipality. HRQOL scores obtained through the Child Health Questionnaire - Parent Form 50 (CHQ-PF50) were compared according to the nutritional status and gender of the children/adolescents. Multiple regression analysis was used to determine the predictive value of studied variables for the variation in HRQOL scores. RESULTS: Parents of children/adolescents with overweight/obesity attributed lower HRQOL scores to their children in the following domains: physical functioning (p < 0.01; d = 0.49), self-esteem (p < 0.01; d = 0.38), parental impact-emotional (p < 0.05; d= 0.29), family cohesion (p < 0.05; d = 0.26), physical summary score (p < 0.05;d = 0.29), and psychosocial summary score (p < 0.05; d = 0.25). In the multiple regression models, the variables with the highest contribution to the variation in HRQOL scores were: in the physical functioning domain, parental impact-time (ß = 0.23; p < 0.05); self-esteem, nutritional status (ß = -0.18;p ≤ 0.01); emotional impact on parents, impact on parents' time (ß = 0.31; p < 0.05); and in family cohesion, global behavior (ß = 0.30;p < 0.05). CONCLUSIONS: A negative impact on HRQOL of children/adolescents with overweight/obesity was observed in the physical and psychosocial aspects. The nutritional status was the variable with the greatest contribution for the assessment the self-esteem of children and adolescents in this study.

RESUMO OBJETIVO: Avaliar a percepção dos pais ou cuidadores a respeito da qualidade de vida relacionada à saúde (QVRS) de crianças/adolescentes com sobrepeso/obesidade e os possíveis fatores associados a essa percepção. MÉTODOS: Estudo transversal com a participação de 297 cuidadores de crianças e adolescentes eutróficos (n = 170) e com sobrepeso/obesidade (n = 127), provenientes de escolas públicas e privadas do município do estudo. Escores de QVRS obtidos por meio do Child Health Questionnaire - Parent Form 50 (CHQ-PF50) foram comparados de acordo com o estado nutricional e sexo das crianças/adolescentes. Análises de regressão múltipla foram usadas para determinar o valor preditivo das variáveis estudadas para a variação dos escores de QVRS. RESULTADOS: Pais de crianças/adolescentes com sobrepeso/obesidade atribuíram menores escores de QVRS para seus filhos nos domínios: função física (p < 0,01; d = 0,49), autoestima (p < 0,01; d = 0,38), impacto emocional dos pais (p < 0,05; d = 0,29), coesão familiar (p < 0,05; d = 0,26), sumário do escore físico (p < 0,05; d = 0,29) e sumário do escore psicossocial (p < 0,05; d = 0,25). Nos modelos de regressão múltipla, as variáveis com maior contribuição para a variação dos escores de QVRS foram: no domínio função física, impacto no tempo dos pais (ß = 0,23; p < 0,05); autoestima, estado nutricional (ß = -0,18; p ≤ 0,01); impacto emocional nos pais, impacto no tempo dos pais (ß = 0,31; p < 0,05); coesão familiar, comportamento global (ß = 0,30; p < 0,05). CONCLUSÕES: Há impacto negativo na QVRS de crianças/adolescentes com sobrepeso/obesidade em aspectos físicos e psicossociais. O estado nutricional foi a variável de maior contribuição para a avaliação da autoestima das crianças e adolescentes do presente estudo.

Parents' perception of health-related quality of life in children and adolescents with excess weight.

OBJECTIVE: To evaluate the perception of parents or caregivers on the health-related quality of life (HRQOL) of children/adolescents with overweight/obesity and possible factors associated with this perception. METHODS: This was a cross-sectional study involving 297 caregivers of children and adolescents with normal weight (n=170) and with overweight/obesity (n=127), from public and private schools in the study municipality. HRQOL scores obtained through the Child Health Questionnaire - Parent Form 50 (CHQ-PF50) were compared according to the nutritional status and gender of the children/adolescents. Multiple regression analysis was used to determine the predictive value of studied variables for the variation in HRQOL scores. RESULTS: Parents of children/adolescents with overweight/obesity attributed lower HRQOL scores to their children in the following domains: physical functioning (p<0.01; d=0.49), self-esteem (p<0.01; d=0.38), parental impact-emotional (p<0.05; d=0.29), family cohesion (p<0.05; d=0.26), physical summary score (p<0.05; d=0.29), and psychosocial summary score (p<0.05; d=0.25). In the multiple regression models, the variables with the highest contribution to the variation in HRQOL scores were: in the physical functioning domain, parental impact-time (ß=0.23; p<0.05); self-esteem, nutritional status (ß=-0.18; p≤0.01); emotional impact on parents, impact on parents' time (ß=0.31; p<0.05); and in family cohesion, global behavior (ß=0.30; p<0.05). CONCLUSIONS: A negative impact on HRQOL of children/adolescents with overweight/obesity was observed in the physical and psychosocial aspects. The nutritional status was the variable with the greatest contribution for the assessment the self-esteem of children and adolescents in this study.

Health-related quality of life and depressive symptoms in undergraduate nursing students.

This is a descriptive, cross-sectional study aimed at investigating the health-related quality of life (HRQoL) of nursing students and its relationship with year of training, sociodemographic variables and the intensity of depressive symptoms. A convenience sample of 256 students, out of 353 eligible (72%), responded to the Medical Outcomes Study - The 36 Item Short-Form Health Survey (SF-36) and the Beck Depression Inventory (BDI) (self-administered). Final-year students, females and students with a higher intensity of depressive symptoms presented lower SF-36 scores in the physical functioning, vitality and social functioning domains. Institutional psychopedagogic support programs may minimize this negative impact on the HRQoL and encourage better professional performance of students in higher vulnerability situations.

Health-related quality of life and depressive symptoms in undergraduate nursing students / Qualidade de vida relacionada à saúde e sintomas depressivos de estudantes do curso de graduação em Enfermagem / Calidad de vida relacionada a la salud y síntomas depresivos de estudiantes del curso de graduación en enfermería

This is a descriptive, cross-sectional study aimed at investigating the health-related quality of life (HRQoL) of nursing students and its relationship with year of training, sociodemographic variables and the intensity of depressive symptoms. A convenience sample of 256 students, out of 353 eligible (72%), responded to the Medical Outcomes Study - The 36 Item Short-Form Health Survey (SF-36) and the Beck Depression Inventory (BDI) (self-administered). Final-year students, females and students with a higher intensity of depressive symptoms presented lower SF-36 scores in the physical functioning, vitality and social functioning domains. Institutional psychopedagogic support programs may minimize this negative impact on the HRQoL and encourage better professional performance of students in higher vulnerability situations.

Trata-se de estudo descritivo e transversal, que investigou a qualidade de vida relacionada à saúde (QVRS) de estudantes de Enfermagem e a relação da QVRS com o ano de estudo, as variáveis sociodemográficas e a intensidade de sintomas depressivos. Uma amostra acidental de 256 estudantes dos 353 elegíveis (72%) respondeu ao Medical Outcomes Study - The 36 Item Short-Form Health Survey (SF-36) e ao Inventário de Depressão de Beck (IDB). Estudantes do último ano do curso, sobretudo do sexo feminino e com maior intensidade de sintomas depressivos, apresentaram menores escores do SF-36 nos domínios capacidade funcional, vitalidade e aspectos sociais. O prejuízo na QVRS ocorre sobretudo no último ano do curso, nos estudantes do sexo feminino ou com sintomas depressivos. Programas institucionais de aconselhamento psicopedagógico poderiam minimizar o impacto negativo detectado na QVRS e contribuir para melhor formação e desempenho profissional dos estudantes em situação de maior vulnerabilidade.

Se trata de un estudio descriptivo y transversal que investigó la calidad de vida relacionada a la salud (CVRS) de los estudiantes de enfermería y la relación con años de estudio, las variables sociodemográficas y la intensidad de los síntomas depresivos. Una muestra accidental de 256 estudiantes de 353 elegibles (72%) respondió el Medical Outcomes Study - The 36 Item Short-Form Health Survey (SF-36) y el Inventario de Depresión de Beck (IDB) (auto-aplicación). Estudiantes del último año del curso, los del sexo femenino y con mayor intensidad de síntomas depresivos, presentaron menores puntuaciones del SF-36 en los dominios capacidad funcional, vitalidad y aspectos sociales. El impacto es mayor en el último año del curso, los estudiantes de sexo femenino o con síntomas depresivos. Programas de apoyo psicológico podrían minimizar este impacto y contribuir a una mejor formación y desempeño profesional de los estudiantes en situación de mayor vulnerabilidad.