Cross-sectional assessment of mild cognitive impairment in pre-dialysis chronic kidney disease and its association with inflammation and changes seen on MRI: what the eyes cannot see / Avaliação transversal do comprometimento cognitivo leve em doença renal crônica pré-dialítica e associação com inflamação e alterações na ressonância magnética: o que os olhos não veem

Abstract Introduction: Mild cognitive impairment (MCI) is a prevalent and underdiagnosed condition in chronic kidney disease (CKD), that shares common pathophysiological factors such as chronic inflammation. Objective: To evaluate the association of MCI in CKD stages 1-5 using inflammatory markers and changes by magnetic resonance imaging (MRI). Patients and Methods: Cross-sectional study in adult patients with pre-dialysis CKD. MCI was assessed by the Montreal Cognitive Assessment (MoCA) and the estimated glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration equation. Sociodemographic and clinical data were collected from medical records. The cytokines IL-4, IL-6, IL-17, TNF-α and hs-CRP were determined. Brain MRI was performed in a 1.5 Tesla device, without paramagnetic contrast. A descriptive analysis followed by a comparison of abnormal versus normal MoCA scores among all studied variables. A linear regression analysis was performed using MoCA as a dependent variable, adjusted for confounding factors. Results: Of 111 invited patients, eighty completed the neuropsychological assessment and 56 underwent MRI, and were included in the study. Mean age was 56.3 ± 8.3 years and 51.8% (n = 29) had altered MoCA. When compared to the group with normal MoCA, the group with altered MoCA had higher levels of IL-6 and IL-17. There was no correlation between altered MoCA with eGFR or with MRI abnormalities. Conclusão: MCI assessed by MoCA was prevalent in patients with pre-dialysis CKD, it was associated with inflammation and showed no correlation with MRI changes.

Resumo Introdução: O comprometimento cognitivo leve (CCL) é prevalente e subdiagnosticado na doença renal crônica (DRC), condição com a qual compartilha fatores fisiopatológicos como a inflamação crônica. Objetivo: Avaliar a associação do CCL na DRC estágios 1 a 5, com marcadores inflamatórios e alterações de exames de imagem por ressonância magnética (RM). Pacientes e métodos: Estudo transversal em pacientes adultos, com DRC pré-dialítica. CCL foi avaliado pelo Montreal Cognitive Assessment (MoCA) e a taxa de filtração glomerular estimada (TFGe), pela equação do CKD-EPI. Dados sociodemográficos e clínicos foram coletados nos prontuários médicos. Dosadas citocinas IL-4, IL-6, IL-17, o TNF-α e PCR-us. A RM do encéfalo foi realizada em aparelho de 1,5 Tesla, sem contraste. Realizada análise descritiva seguida por comparação de pontuações do MoCA anormais versus normais entre todas as variáveis estudadas. A regressão linear foi realizada usando MoCA como uma variável dependente, ajustada para fatores de confusão. Resultados: De 111 pacientes convidados, oitenta completaram a avaliação neuropsicológica, 56 realizaram RM, tendo sido incluídos no estudo. A média de idade foi de 56,3 ± 8,3 anos e 51,8% (n = 29) apresentavam MoCA alterado. Quando comparado ao grupo MoCA normal, o grupo MoCA alterado apresentou níveis mais elevados de IL-6 e IL-17. Não houve correlação entre MoCA alterado com TFGe nem com anormalidades na RM. Nos modelos ajustados, a IL-6 foi preditor independente do MoCA alterado Conclusão: O CCL avaliado pelo MoCA foi prevalente em pacientes com DRC pré-dialítica, associou-se com inflamação e não apresentou correlação com alterações da RM.

Cross-sectional assessment of mild cognitive impairment in pre-dialysis chronic kidney disease and its association with inflammation and changes seen on MRI: what the eyes cannot see.

INTRODUCTION: Mild cognitive impairment (MCI) is a prevalent and underdiagnosed condition in chronic kidney disease (CKD), that shares common pathophysiological factors such as chronic inflammation. OBJECTIVE: To evaluate the association of MCI in CKD stages 1-5 using inflammatory markers and changes by magnetic resonance imaging (MRI). PATIENTS AND METHODS: Cross-sectional study in adult patients with pre-dialysis CKD. MCI was assessed by the Montreal Cognitive Assessment (MoCA) and the estimated glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration equation. Sociodemographic and clinical data were collected from medical records. The cytokines IL-4, IL-6, IL-17, TNF-α and hs-CRP were determined. Brain MRI was performed in a 1.5 Tesla device, without paramagnetic contrast. A descriptive analysis followed by a comparison of abnormal versus normal MoCA scores among all studied variables. A linear regression analysis was performed using MoCA as a dependent variable, adjusted for confounding factors. RESULTS: Of 111 invited patients, eighty completed the neuropsychological assessment and 56 underwent MRI, and were included in the study. Mean age was 56.3 ± 8.3 years and 51.8% (n = 29) had altered MoCA. When compared to the group with normal MoCA, the group with altered MoCA had higher levels of IL-6 and IL-17. There was no correlation between altered MoCA with eGFR or with MRI abnormalities. CONCLUSÃO: MCI assessed by MoCA was prevalent in patients with pre-dialysis CKD, it was associated with inflammation and showed no correlation with MRI changes.

Aspectos psicossociais da gestação de alto risco: análise de mulheres grávidas hospitalizadas / Psychosocial aspects of high-risk pregnancy: analysis of hospitalized pregnant women / Aspectos psicosociales de la gestación de alto riesgo: análisis de mujeres embarazadas hospitalizadas

A gestação de alto risco é caracterizada por ser um momento em que a vida ou a saúde da mãe e/ou do feto e/ou do recém-nascido está submetida a maiores chances de morte que a média da população considerada. O estudo objetivou apresentar dados sobre o perfil de gestantes de alto risco e identificar os aspectos psicossociais ligados à gravidez. A amostra foi composta por 74 mulheres grávidas em um hospital no município de Juiz de Fora, MG. Elas responderam ao PHQ-2, a EPSS, ao IDATE, ao ASSIST e a um questionário sociodemográfico e clínico. Foi possível observar a prevalência de sintomas de depressão, ansiedade, baixo suporte social e uso de substâncias na população avaliada. As análises confirmaram correlações entre características sociodemográficas, clínicas e aspetos psicossociais. Os resultados demonstram a relevância de se conhecer o perfil dessas mulheres para a melhora na elaboração de estratégias de suporte direcionadas ao enfrentamento de possíveis fatores que possam interferir no bom andamento da gestação.

The high-risk pregnancy is characterized for being a moment that the life or health of the mother and/or fetus and/or newborn is subjected to higher risks of death compared to the average population. The study aimed to present data concerning the profile of high risks pregnancy and determine psychosocial aspects about high-risk. The sample was composed by 74 pregnant women in a hospital located in Juiz de Fora/MG, Brazil. The instruments applied were: PHQ-2, PSSS, STAI, ASSIST and a sociodemographic and clinical survey. It was possible to identify the prevalence of depressive symptoms, anxiety, reduced social support and inappropriate substance use in this population. The analyzes confirmed correlations between sociodemographic, clinical, and psychosocial aspects. The results demonstrate the relevance of knowing the profile of these women to improve the formulation of supportive strategies, directing to confront possible factors that may interfere the good progress of the gestation.

La gestación de alto riesgo se caracteriza por ser un momento que la vida o la salud de la madre y/o del feto está sometida a mayores riesgos de la muerte que la media de la población considerada. El estudio objetivó presentar datos sobre el perfil de gestantes de alto riesgo e identificar los aspectos psicosociales ligados al embarazo de riesgo. Se realizó con 74 mujeres clasificadas en el perfil de gestación de alto riesgo en un hospital en el municipio de Juiz de Fora / MG. Ellas respondieron al PHQ-2, a la EPSS, al IDATE, al ASSIST y a un cuestionario sociodemográfico y clínico. Los análisis confirmaron correlaciones entre características sociodemográficas, clínicas y aspectos psicosociales. Los resultados demuestran la relevancia de conocer el perfil de esas mujeres para mejorar en la elaboración de estrategias de soporte dirigidas al enfrentamiento de factores que puedan interferir en el buen andamiento de la gestación.

Baixo letramento em saúde em pacientes idosos com pressão arterial não controlada em nível secundário de atenção à saúde / Low health literacy in older patients with uncontrolled blood pres-sure at secondary care

Introdução: O baixo letramento em saúde (BLS) é comum entre pacientes com doenças crônicas. Os estudos sobre a associação entre o BLS e a pressão arterial não controlada estão limitados aos níveis primário e terciário de atenção à saúde. Objetivo: Avaliamos a prevalência e a associação entre BLS e pressão arterial não controlada em pacientes hipertensos em um centro de atenção secundária à saúde no Brasil. Material e métodos: Nosso estudo teve delineamento transversal e incluiu 485 pacientes, no período de Agosto/2014 a Março/2016. Avaliamos letramento em saúde, pelo Short Assessment of Health Literacy for Portuguese-Speaking Adults (SAHLPA-18), e controle pressórico. Indivíduos com um escore ≤14 em SAHLPA-18 foram considerados com BLS, e indivíduos com pressão arterial ≥140/90 (ou ≥130/80 em pacientes diabéticos) foram considerados como tendo pressão arterial não controlada. Resultados:Um total de 56,0% eram mulheres, com média de idade de 62,0±12,6 anos. Os participantes analfabetos eram 61,6% e 65,4% recebiam até um salário mínimo. Tanto a pressão arterial não controlada quanto o BLS foram muito prevalentes (75,1% e 70,9%, respectivamente), entretanto não houve associação entre esses dois parâmetros. Na análise multivariada, a pressão arterial não controlada foi associada à idade (OR:0,96, IC:0,94-0,98, p<0,001), diabetes mellitus (OR:4,36, IC:2,54-7,51; p<0,001) e número de comprimidos (OR:1,16, Cl:1,08-1,25, p<0,001). Conclusão: Mesmo encontrando alta prevalência de BLS, a falta de associação entre BLS e pressão arterial não controlada pode ser devido às características demográficas da amostra, ou seja, idosos com baixa renda e baixa escolaridade. A avaliação do letramento em saúde fornece informações importantes que apoiam ações para melhorar o controle e o tratamento da hipertensão.

Background: Low health literacy (LHL) is common among patients with chronic diseases. Studies on the association between LHL and uncontrolled blood pressure are limited to primary and tertiary levels of healthcare. Objective:We evaluated the prevalence and association between LHL and uncontrolled blood pressure in hypertensive patients in a secondary healthcare in Brazil. Material and methods: Our study had a cross-sectional design and included 485 patients, between August/2014 to March/2016. We evaluated health literacy, by Short Assessment of Health Literacy for Portuguese-Speaking Adults (SAHLPA-18), and the blood pressure control. Individuals with a score ≤14 in SAHLPA-18 were considered as LHL, and individuals with blood pressure ≥140/90 (or ≥130/80 in diabetic patients) were considered as having uncontrolled blood pressure. Results: A total of 56.0% female, with mean age 62.0±12.6 years. Illiterate participants were 61.6%, and 65.4% earned up to one reference wage. Both uncontrolled blood pressure and LHL were highly prevalent (75.1% and 70.9%, respectively), but there was no association between these two parameters. In multivariate analysis, uncontrolled blood pressure was associated with age (OR:0.96, CI:0.94-0.98, p<0.001), diabetes mellitus (OR:4.36, CI:2.54-7.51; p<0.001) and number of pills (OR:1.16, CI:1.08-1.25, p<0.001). Conclusion: Even we found a high prevalence of LHL, the lack of association between LHL and uncontrolled blood pressure may be due to demographic characteristics of the sample, i.e., elderly people with low income and low schooling. HL assessment provides important information that supports actions to improve hypertension control and treatment.

Evaluation of prevalence, biochemical profile, and drugs associated with chronic kidney disease-mineral and bone disorder in 11 dialysis centers.

INTRODUCTION: The diagnosis and treatment of mineral and bone disorder of chronic kidney disease (CKD-MBD) is a challenge for nephrologists and health managers. The aim of this study was to evaluate the prevalence, biochemical profile, and drugs associated with CKD-MBD. METHODS: Cross-sectional study between July and November 2013, with 1134 patients on dialysis. Sociodemographic, clinical, and laboratory data were compared between groups based on levels of intact parathyroid hormone (iPTH) (< 150, 150-300, 301-600, 601-1000, and > 1001 pg/mL). RESULTS: The mean age was 57.3 ± 14.4 years. The prevalence of iPTH < 150 pg/mL was 23.4% and iPTH > 601 pg/mL was 27.1%. The comparison between the groups showed that the level of iPTH decreased with increasing age. Diabetic patients had a higher prevalence of iPTH < 150 pg/mL (27.6%). Hyperphosphatemia (> 5.5 mg/dL) was observed in 35.8%. Calcium carbonate was used by 50.5%, sevelamer by 14.7%, 40% of patients had used some form of vitamin D and 3.5% used cinacalcet. Linear regression analysis showed a significant negative association between iPTH, age, and diabetes mellitus and a significant positive association between iPTH and dialysis time. CONCLUSION: The prevalence of patients outside the target for iPTH was 50.5%. There was a high prevalence of hyperphosphatemia (35.8%), and the minority of patients were using active vitamin D, vitamin D analogs, selective vitamin D receptor activators, and cinacalcet. These data indicate the need for better compliance with clinical guidelines and public policies on the supply of drugs associated with CKD-MBD.

Evaluation of prevalence, biochemical profile, and drugs associated with chronic kidney disease-mineral and bone disorder in 11 dialysis centers / Avaliação da prevalência, perfil bioquímico e drogas associadas ao distúrbio mineral ósseo-doença renal crônica em 11 centros de diálise

ABSTRACT Introduction: The diagnosis and treatment of mineral and bone disorder of chronic kidney disease (CKD-MBD) is a challenge for nephrologists and health managers. The aim of this study was to evaluate the prevalence, biochemical profile, and drugs associated with CKD-MBD. Methods: Cross-sectional study between July and November 2013, with 1134 patients on dialysis. Sociodemographic, clinical, and laboratory data were compared between groups based on levels of intact parathyroid hormone (iPTH) (< 150, 150-300, 301-600, 601-1000, and > 1001 pg/mL). Results: The mean age was 57.3 ± 14.4 years. The prevalence of iPTH < 150 pg/mL was 23.4% and iPTH > 601 pg/mL was 27.1%. The comparison between the groups showed that the level of iPTH decreased with increasing age. Diabetic patients had a higher prevalence of iPTH < 150 pg/mL (27.6%). Hyperphosphatemia (> 5.5 mg/dL) was observed in 35.8%. Calcium carbonate was used by 50.5%, sevelamer by 14.7%, 40% of patients had used some form of vitamin D and 3.5% used cinacalcet. Linear regression analysis showed a significant negative association between iPTH, age, and diabetes mellitus and a significant positive association between iPTH and dialysis time. Conclusion: The prevalence of patients outside the target for iPTH was 50.5%. There was a high prevalence of hyperphosphatemia (35.8%), and the minority of patients were using active vitamin D, vitamin D analogs, selective vitamin D receptor activators, and cinacalcet. These data indicate the need for better compliance with clinical guidelines and public policies on the supply of drugs associated with CKD-MBD.

RESUMO Introdução: O diagnóstico e tratamento do distúrbio mineral ósseo-doença renal crônica (DMO-DRC) é um desafio para os nefrologistas e gestores de saúde. O objetivo deste estudo foi avaliar a prevalência, perfil bioquímico, e drogas associadas a DMO-DRC. Métodos: Estudo transversal entre julho e novembro de 2013, em 11 centros com 1134 pacientes em diálise. Dados sociodemográficos, clínicos, e laboratoriais foram comparados entre os grupos, com base em níveis do paratormônio intacto (PTHi) (< 150,151-300, 301-600,601-1000, e > 1001 pg/mL). Resultados: A idade média foi de 57,3 ± 14,4 anos, 1071 pacientes estavam em hemodiálise, e 63 em diálise peritoneal. A prevalência de PTHi < 150 pg/mL foi 23,4% e PTHi > 601 pg/mL foi de 27,1%. A comparação dos grupos mostrou que o nível de PTHi diminuiu com o aumento da idade. Pacientes diabéticos apresentaram uma maior prevalência de PTHi < 150 pg/mL (27,6%). Carbonato de cálcio foi usado por 50,5%, Sevelamer por 14,7%, 40% dos pacientes utilizaram alguma forma de vitamina D, e 3,5% utilizaram cinacalcet. A hiperfosfatemia (> 5,5mg/dL) foi observada em 35,8%. A análise de regressão linear mostrou uma associação negativa significativa entre PTHi, idade, e diabetes mellitus e uma associação positiva significativa com o tempo em diálise. Conclusão: A prevalência de pacientes fora do alvo para PTHi foi de 50,5%. Houve uma alta prevalência de hiperfosfatemia e um baixo uso de vitamina D ativa, análogos da vitamina D, ativadores seletivos da vitamina D, e cinacalcet. Estes dados chamam a atenção para a necessidade de uma maior conformidade com as diretrizes e políticas públicas sobre o fornecimento de medicamentos associados à DMO-DRC.

Beyond quality of life: a cross sectional study on the mental health of patients with chronic kidney disease undergoing dialysis and their caregivers.

BACKGROUND: Patients with terminal chronic kidney disease (CKDT) requiring renal replacement therapies (RRT) undergo important changes in living habits and frequently need caregiving. These patients and their caregivers are risk groups for the development of physical and psychological symptoms. This study aimed to evaluate the prevalence of anxiety, depression, stress, fatigue, social support, and quality of life in patients with CKD and their caregivers. METHOD: This cross sectional study was conducted with 21 patients and their caregivers, from January to September 2015. We included patients aged over 18 years, with at least 6 months on dialysis treatment, and caregivers who were family members. The participants' social, demographic, clinical, laboratory, and psychological variables were evaluated. A descriptive analysis and an examination of the association between patients and caregivers were performed. RESULTS: Among patients, we observed that 38.1% had symptoms that indicated anxiety and depression. The average score for practical social support was 3.15 ± 0.769 and that for emotional social support was 3.16 ± 0.79. As for fatigue, 14.3% of patients reported being 'extremely tired' and 14.3% reported that they engaged in all the activities they usually performed before the illness. Further, 57.1% presented stress, and of these, 66.7% were at the resistance stage, with predominance of psychological symptoms in 60.0%. The quality of life domain in terms of functional capacity (FC) presented a correlation with haemoglobin level (r = 0.581, p = 0.006) and non-anaemic patients presented better FC. Among caregivers, we observed symptoms that indicated anxiety and depression in 33.3% of the sample. Caregivers exhibited an average score of 2.88 ± 0.77 for practical social support and 3.0 ± 0.72 for emotional social support. Further, 14.3% reported being 'extremely tired' and 28.8% reported that they engaged in all activities that they usually performed before the patient's illness. When comparing the two groups (patients vs. caregivers), we observed that they presented similar results for the presence of anxiety, depression, and fatigue. Caregivers received less social support than patients did. Both groups presented similar predominance of stress levels; however, patients presented more predominance of psychological symptoms. With reference to quality of life, patients and caregivers presented similar results on the social aspects, vitality, mental health, and mental domains. CONCLUSION: The mental health characteristics of patients and caregivers were similar, and within the context of dialysis for renal disease, both must undergo specific interventions.

Multilevel Correlates of Non-Adherence in Kidney Transplant Patients Benefitting from Full Cost Coverage for Immunosuppressives: A Cross-Sectional Study.

BACKGROUND: Adherence is the result of the interaction of the macro, meso, micro, and patient level factors. The macro level includes full coverage of immunosuppressive medications as is the case in Brazil. We studied the correlates of immunosuppressive non-adherence in post kidney transplant patients in the Brazilian health care system. METHODS: Using a cross-sectional design, adherence to immunosuppressives was assessed in a sample of 100 kidney transplant patients using a composite non-adherence score consisting of three methods (self-report [i.e., The Basel Adherence Scale for Assessment of Immunossupressives-BAASIS], collateral report, and immunosuppressive blood levels). Multilevel correlations of non-adherence were assessed (macro, meso, micro and patient level). Univariate and multivariate logistic regression was applied to assess the correlates of non-adherence. RESULTS: Our sample consisted primarily of male (65%), Caucasians (72%) with a mean age of 45.0 ± 13.5 years old, who received grafts from a living donor (89%), with a mean time after transplantation of 72.3 ± 44.4 months. Prevalence of non-adherence was 51%. Family income higher than five reference wages (21.6 vs. 4%; OR 6.46 [1.35-30.89], p = 0.009; patient level), and having access to private health insurance (35.3% vs. 18.4%; OR 2.42 [0.96-6.10], p = 0.04; meso level) were associated with non-adherence in univariate analysis. Only the higher family income variable was retained in the multiple logistic regression model (OR 5.0; IC: 1.01-25.14; p = 0.04). CONCLUSIONS: Higher family income was the only factor that was associated with immunosuppressive non-adherence. In Brazil, lower income recipients benefit from better access to care and coverage of health care costs after transplantation. This is supposed to result in a better immunosuppressive adherence compared to high-income patients who have experienced these benefits continuously.

Nomogram for estimating glomerular filtration rate in elderly people.

After the second decade of life, the glomerular filtration rate (GFR) decreases progressively. There is still considerable debate about the importance of this "physiological decrease" in GFR with age in many situations attributed to the effects of concomitant hypertension, atherosclerosis, cardiovascular diseases (among others) observed in the elderly. The GFR is considered the best indicator of renal function and its estimate has been suggested in the guidelines of chronic kidney disease (CKD). However, in the most commonly equations used, the elderly subjects were not included or were underrepresented. The purpose of this is to describe a nomogram based on an equation to estimate GFR based on serum creatinine, age and sex that was developed for the study Berlin Initiative Study (only individuals older than 70 years were included). The performance of the equation, called BIS1 was compared with Hioxal (gold standard), three equations based on serum creatinine (CG, MDRD and CKD-EPI) and three equations based on cystatin C (proposed by the CKD-EPI) and the second showed less bias among that another equations and compared the CG, MDRD and CKD-EPI equations, had the lowest rate of misclassification of CKD in participants with less than 60 mL/min/1.73 m2.

Nomograma para a estimativa da taxa de filtração glomerular em indivíduos idosos / Nomogram for estimating glomerular filtration rate in elderly people

ResumoApós a segunda década de vida, a taxa de filtração glomerular (TFG) diminui progressivamente. Ainda existe considerável debate sobre a importância desta "diminuição fisiológica" da TFG com a idade, em muitas situações atribuídas aos efeitos da concomitância de hipertensão arterial, aterosclerose, doenças cardiovasculares (entre outras) observadas nos idosos. A TFG é considerada a melhor indicação da função renal e sua estimativa tem sido sugerida nas principais diretrizes sobre doença renal crônica (DRC). Contudo, nas equações mais comumente utilizadas os indivíduos idosos não foram incluídos ou estavam sub-representados. O objetivo desta é descrever um nomograma baseado em uma equação para estimar a TFG baseada na creatinina, sexo e idade (foram incluídos apenas indivíduos com mais de 70 anos de idade) que foi desenvolvida para o estudo Berlin Initiative Study. A performance da equação, denominada BIS1, foi comparada com o Hioxal (padrão ouro), três equações baseadas na creatinina (CG, MDRD e CKD-EPI) e três equações baseadas na cistatina C (propostas pelo CKD-EPI) e demonstrou o segundo menor viés entre todas as equações e, quando comparada as equações CG, MDRD e CKD-EPI, apresentou a menor taxa de classificação errônea da DRC nos participantes com menos de 60 mL/min/1,73 m2.

AbstractAfter the second decade of life, the glomerular filtration rate (GFR) decreases progressively. There is still considerable debate about the importance of this "physiological decrease" in GFR with age in many situations attributed to the effects of concomitant hypertension, atherosclerosis, cardiovascular diseases (among others) observed in the elderly. The GFR is considered the best indicator of renal function and its estimate has been suggested in the guidelines of chronic kidney disease (CKD). However, in the most commonly equations used, the elderly subjects were not included or were underrepresented. The purpose of this is to describe a nomogram based on an equation to estimate GFR based on serum creatinine, age and sex that was developed for the study Berlin Initiative Study (only individuals older than 70 years were included). The performance of the equation, called BIS1 was compared with Hioxal (gold standard), three equations based on serum creatinine (CG, MDRD and CKD-EPI) and three equations based on cystatin C (proposed by the CKD-EPI) and the second showed less bias among that another equations and compared the CG, MDRD and CKD-EPI equations, had the lowest rate of misclassification of CKD in participants with less than 60 mL/min/1.73 m2.

Variáveis do contexto escolar como preditoras da autoeficácia e ansiedade de estudantes / School context variables as predictors of self-efficacy and anxiety of students / Variables de contexto escolar como predictores de la autoeficacia y la ansiedad de los estudiantes

A ampliação das políticas públicas de avaliação educacional em larga escala trouxe atenção ao papel dos aspectos econômicos, sociais e psicológicos ligados ao desempenho escolar dos estudantes. O presente estudo investigou a associação entre as variáveis socioemocionais ansiedade e autoeficácia com as variáveis sociodemográficas e do contexto escolar no 5º e 9º ano do ensino fundamental e do 3º ano do ensino médio da rede pública do estado de Minas Gerais. Utilizou-se o método de modelagem multinível em cada ano escolar, e os resultados indicaram que as variáveis do contexto escolar influenciam a expressão da ansiedade e das crenças de autoeficácia dos estudantes. Concluiu-se que intervenções individuais e de organização do espaço escolar podem contribuir para a construção de um espaço propício para a aprendizagem e para a melhoria da equidade.(AU)

The expansion of public policies of large scale assessment in Education has brought attention to the economic, social and psychological aspects associated with students’ school performance. This study investigated the association between sociodemographic variables and the noncognitive variables of socio-emotional anxiety and self-efficacy, and of the school context in the 5th and 9th grades of elementary school and the 3rd year of secondary education in public schools in the state of Minas Gerais. We used the hierarchical multilevel modeling method in each grade, and the results indicated that the variables of school context affect the expression of selfefficacy beliefs and students anxiety. The results show that individual interventions and the school environment organization could contribute to providing a more suitable learning environment and to improve equity.(AU)

Con la expansión de las políticas públicas de evaluación en gran escala en el área de la educación se ha dado atención a las esferas económica y social y los aspectos psicológicos relacionados con el desempeño escolar de los estudiantes. El presente estudio investigó la asociación entre las variables no-cognitivas ansiedad y la auto-eficacia con variables de contexto escolar en el 5º y 9º grado de la escuela primaria, y 3o grado de la escuela secundaria de las escuelas públicas del estado de Minas Gerais. Lo hicimos con el método de la modelación multinivel en cada una de las categorías y los resultados indican que las variables de contexto escolar afecta a la expresión de la auto-eficacia y ansiedad en los estudiantes. Los resultados muestran que las intervenciones individuales y la organización de entorno escolar podrían contribuir a proporcionar un ambiente de aprendizaje más adecuado y mejorar la equidad.(AU)

Variáveis do contexto escolar como preditoras da autoeficácia e ansiedade de estudantes / School context variables as predictors of self-efficacy and anxiety of students / Variables de contexto escolar como predictores de la autoeficacia y la ansiedad de los estudiantes

A ampliação das políticas públicas de avaliação educacional em larga escala trouxe atenção ao papel dos aspectos econômicos, sociais e psicológicos ligados ao desempenho escolar dos estudantes. O presente estudo investigou a associação entre as variáveis socioemocionais ansiedade e autoeficácia com as variáveis sociodemográficas e do contexto escolar no 5º e 9º ano do ensino fundamental e do 3º ano do ensino médio da rede pública do estado de Minas Gerais. Utilizou-se o método de modelagem multinível em cada ano escolar, e os resultados indicaram que as variáveis do contexto escolar influenciam a expressão da ansiedade e das crenças de autoeficácia dos estudantes. Concluiu-se que intervenções individuais e de organização do espaço escolar podem contribuir para a construção de um espaço propício para a aprendizagem e para a melhoria da equidade...

The expansion of public policies of large scale assessment in Education has brought attention to the economic, social and psychological aspects associated with students’ school performance. This study investigated the association between sociodemographic variables and the noncognitive variables of socio-emotional anxiety and self-efficacy, and of the school context in the 5th and 9th grades of elementary school and the 3rd year of secondary education in public schools in the state of Minas Gerais. We used the hierarchical multilevel modeling method in each grade, and the results indicated that the variables of school context affect the expression of selfefficacy beliefs and students anxiety. The results show that individual interventions and the school environment organization could contribute to providing a more suitable learning environment and to improve equity...

Con la expansión de las políticas públicas de evaluación en gran escala en el área de la educación se ha dado atención a las esferas económica y social y los aspectos psicológicos relacionados con el desempeño escolar de los estudiantes. El presente estudio investigó la asociación entre las variables no-cognitivas ansiedad y la auto-eficacia con variables de contexto escolar en el 5º y 9º grado de la escuela primaria, y 3o grado de la escuela secundaria de las escuelas públicas del estado de Minas Gerais. Lo hicimos con el método de la modelación multinivel en cada una de las categorías y los resultados indican que las variables de contexto escolar afecta a la expresión de la auto-eficacia y ansiedad en los estudiantes. Los resultados muestran que las intervenciones individuales y la organización de entorno escolar podrían contribuir a proporcionar un ambiente de aprendizaje más adecuado y mejorar la equidad...

Longitudinal changes in health-related quality of life scores in Brazilian incident peritoneal dialysis patients (BRAZPD): socio-economic status not a barrier.

BACKGROUND AND OBJECTIVES: A large proportion of the patients on peritoneal dialysis (PD) in Brazil have low levels of education and family income. The present study assessed whether education level and family income are associated with baseline and longitudinal changes in health-related quality of life (HRQOL) scores during the first year of PD therapy. METHODS: We evaluated 1624 incident patients from the Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD) at baseline, and 486 of them after 12 months. The SF-36 was used to determine HRQOL and the Karnofsky index (KI), physical performance. RESULTS: At baseline, patients received high KI scores compared with scores on the SF-36. The means of the mental and physical components at baseline and after 12 months were 39.9 ± 10.5 compared with 38.7 ± 11.7 and 41.8 ± 9.6 compared with 40.7 ± 9.8 respectively, which were not statistically different. A multivariate regression analysis showed that age, sex, diabetes, and cardiovascular disease were predictors of the mental component (respectively, ß = 0.12, p < 0.001; ß = 0.11, p < 0.001; ß = -0.08, ß = 0.007; and ß = -0.07, p = 0.007) and that age, sex, diabetes, cardiovascular disease, hemoglobin, glucose, and creatinine were predictors of the physical component (respectively, ß = -0.28, p < 0.001; ß = 0.06, p = 0.009; ß = -0.09, p = 0.002; ß = -0.09, p = 0.001; ß = 0.07, p = 0.004; ß = -0.05, p = 0.040; and ß = 0.05, p = 0.040). Education level and family income were not significantly associated with HRQOL (mental and physical components) in the multivariate regression. CONCLUSIONS: The results indicate that, as predictors, family income and education level have no impact on HRQOL, supporting the idea that socio-economic status should not be a barrier to the selection of PD as a treatment modality in Brazil.

Transcultural adaptation and initial validation of Brazilian-Portuguese version of the Basel assessment of adherence to immunosuppressive medications scale (BAASIS) in kidney transplants.

BACKGROUND: Transplant recipients are expected to adhere to a lifelong immunosuppressant therapeutic regimen. However, nonadherence to treatment is an underestimated problem for which no properly validated measurement tool is available for Portuguese-speaking patients. We aimed to initially validate the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS®) to accurately estimate immunosuppressant nonadherence in Brazilian transplant patients. METHODS: The BAASIS® (English version) was transculturally adapted and its psychometric properties were assessed. The transcultural adaptation was performed using the Guillemin protocol. Psychometric testing included reliability (intraobserver and interobserver reproducibility, agreement, Kappa coefficient, and the Cronbach's alpha) and validity (content, criterion, and construct validities). RESULTS: The final version of the transculturally adapted BAASIS® was pretested, and no difficulties in understanding its content were found. The intraobserver and interobserver reproducibility variances (0.007 and 0.003, respectively), the Cronbach's alpha (0.7), Kappa coefficient (0.88) and the agreement (95.2%) suggest accuracy, preciseness and reliability. For construct validity, exploratory factorial analysis demonstrated unidimensionality of the first three questions (r = 0.76, r = 0.80, and r = 0.68). For criterion validity, the adapted BAASIS® was correlated with another self-report instrument, the Measure of Adherence to Treatment, and showed good congruence (r = 0.65). CONCLUSIONS: The BAASIS® has adequate psychometric properties and may be employed in advance to measure adherence to posttransplant immunosuppressant treatments. This instrument will be the first one validated to use in this specific transplant population and in the Portuguese language.

Qualidade de vida em mulheres praticantes de Hatha Ioga / Quality of life in female practitioners of Hatha Yoga

O objetivo do presente estudo foi avaliar, em um grupo de mulheres saudáveis, os efeitos da prática regular de Ioga sobre a qualidade de vida. Tratou-se de um estudo transversal controlado, no qual participaram 25 mulheres saudáveis, com idades entre 20 e 59 anos, divididas nos grupos IOGA (praticantes há pelo menos seis meses) e CONTROLE (sedentárias), compostos respectivamente por 13 e 12 voluntárias. A qualidade de vida foi avaliada utilizando-se o questionário SF-36. Para análise estatística foram realizados o teste t independente e as provas não paramétricas de Mann-Whitney. O grupo IOGA apresentou pontuação significativamente mais elevada no domínio “dor” e no escore físico geral (p < 0,05) do questionário SF-36. Concluímos que, na população avaliada, a prática regular de Hatha Ioga demonstrou ser capaz de influenciar positivamente determinados aspectos da qualidade de vida.

The aim of the present study was to evaluate, in a group of healthy women, whether the regular practice of Hatha Yoga could have an impact on their quality of life. It was a transversal controlled study, composed by 25 women, aged between 20 and 59 years, divided in two groups: YOGA (at least six months of Hatha Yoga practice) and CONTROL (non-active women), composed by 13 and 12 volunteers, respectively. The quality of life was assessed through the SF-36 questionnaire. The statistical procedures included the independent t test and the Mann-Whitney tests. The YOGA group presented higher scores in the “body pain” domain and in the general physical score (p < 0,05). It can be concluded that, in the assessed population, the regular practice of Hatha Yoga has positively influenced some aspects of the quality of life.

A expectativa do professor e o desempenho dos alunos / Teacher's expectation and students' performance

Este trabalho enfoca dois aspectos fundamentais na interação professor-aluno: a sintonia entre o professor e sua turma, e a expectativa do professor quanto ao desempenho dos alunos. Cruzando-se informações de diferentes instrumentos contextuais, aplicados aos professores e alunos, com os resultados dos testes cognitivos dos alunos, pôde-se identificar os fatores que distorcem a percepção do professor acerca da turma e influenciam sua expectativa. Constatou-se que a expectativa do professor é influenciada por suas percepções em relação ao ambiente escolar e pelas características sociodemográficas dos alunos. Observou-se que a expectativa do professor provoca um impacto positivo na proficiência do aluno, mesmo considerando-se o efeito de variáveis sociodemográficas tradicionalmente associadas ao desempenho. Essas conclusões foram obtidas a partir da construção de modelos hierárquicos.(AU)

This work focus on two basic aspects on teacher-student interaction: the tune between teacher and their class, and teacher's expectation with regard to students' performance. When cross analyzing the information of different contextual instruments, applied to teachers and students, with results of the students' cognitive tests, it was possible to identify the factors that distort the teacher's perception about the class and influence his/her expectation. It was noticed that the teacher's expectation is influenced by his/her perceptions in relation to the school environment and the students' social-demographic characteristics. It was observed that the teacher's expectation provokes a positive impact on the student's proficiency, even when it is considered the effect of social-demographic variables, which are traditionally associated to the performance. All these conclusions were obtained by constructing hierarchical models.(AU)

A expectativa do professor e o desempenho dos alunos / Teacher's expectation and students' performance

Este trabalho enfoca dois aspectos fundamentais na interação professor-aluno: a sintonia entre o professor e sua turma, e a expectativa do professor quanto ao desempenho dos alunos. Cruzando-se informações de diferentes instrumentos contextuais, aplicados aos professores e alunos, com os resultados dos testes cognitivos dos alunos, pôde-se identificar os fatores que distorcem a percepção do professor acerca da turma e influenciam sua expectativa. Constatou-se que a expectativa do professor é influenciada por suas percepções em relação ao ambiente escolar e pelas características sociodemográficas dos alunos. Observou-se que a expectativa do professor provoca um impacto positivo na proficiência do aluno, mesmo considerando-se o efeito de variáveis sociodemográficas tradicionalmente associadas ao desempenho. Essas conclusões foram obtidas a partir da construção de modelos hierárquicos.

This work focus on two basic aspects on teacher-student interaction: the tune between teacher and their class, and teacher's expectation with regard to students' performance. When cross analyzing the information of different contextual instruments, applied to teachers and students, with results of the students' cognitive tests, it was possible to identify the factors that distort the teacher's perception about the class and influence his/her expectation. It was noticed that the teacher's expectation is influenced by his/her perceptions in relation to the school environment and the students' social-demographic characteristics. It was observed that the teacher's expectation provokes a positive impact on the student's proficiency, even when it is considered the effect of social-demographic variables, which are traditionally associated to the performance. All these conclusions were obtained by constructing hierarchical models.

Avaliação comparativa da sedimentoscopia urinária realizada pelo nefrologista e pelo profissional de análises clínicas em pacientes com glomerulopatias / Comparative assessment of urinary sediment done by the nephrologist and by the clinical analyst professional in patients with glomerulonephritis

Introdução: A sedimentoscopia urinária com microscópio munido com contraste de fase (MCF) deveria ser a primeira etapa na determinação da origemdas hematúrias. Objetivo: Avaliar discrepâncias nas descrições dos parâmetros urinários relacionados à origem das hematúrias, comparando as descrições do nefrologista (Nef) e do profissional de análises clínicas (PAC). Métodos: Urinas de pacientes com glomerulopatias (GP) confirmadas por biópsia renal foram analisadas sob MCF, por um Nef e um PAC, ambos sem conhecimento prévio da origem das amostras. Cilindros hemáticos, acantocitúria ou células G1 >5% e dismorfismo eritrocitário foram utilizados na localização glomerular das hematúrias. Resultados: Dos 28 pacientes, 13 pacientes (46,4%) apresentavam glomerulonefrites não proliferativas e 15 (53,6%) glomerulonefrites proliferativas. Comparativamente ao PAC, o Nef identificou maior número de hemácias (mediana/mL de urina, 80.000 vs 4.800, p=0,001), maior número de cilindros hemáticos (39,3% vs 0%, p=0,001), maior freqüência de acantocitúria ou células G1 >5% (35,7% vs. 7,14%, p=0,021) e de dismorfismo eritrocitário (96,2% vs 7,14%, p<0,001). As discrepâncias dos resultados permaneceram após a separação das glomerulopatias em proliferativas e não proliferativas. Conclusão: Os parâmetros urinários que caracterizam a origem da hematúria foram mais freqüentemente identificados pelo nefrologista e sugerem que a urinálise, pela sua simplicidade e grande valor informativo, deveria ser incluída obrigatoriamente nos programas de treinamento em nefrologia.

Introduction: In the assessment of hematuria, the first step should be the identification of the origin of the bleeding, which can be done easily by analyzing the urine under phase-contrast microscopy. Obective: To assess the discrepancy of reports of the urinary parameters utilized in the localization of the glomerular origin of hematuria, comparing reports by the nephrologists and by the clinical laboratory technologist. Methods: Urines of patients with biopsy proven glomerulonephritis were assessed under phase-contrast microscopy by a nephrologist and a clinical laboratory technologist, both without previous knowledge of the origin of the samples. Red blood cell (RBC) casts, urinary acanthocytes or G1 cells >5%, and erithrocyte dysmorphism were used tolocalize the glomerular bleeding. Results: Among 28 patients, 13 (46.4%) had non proliferative glomerulonephritis and 15 (53.6%) had proliferative glomerulonephritis. Relatively to the clinical laboratory technologist, the nephrologist identified more RBC (median of 80.000 vs 4.800, p= 0.001), more RBC casts (39.3% vs 0%, p=0.001), more urinary acanthocytes or G1 cells >5% (35.7% vs 7.14%, p=0.021) and more dysmorphic RBC (96.2% vs 7.14%,p<0.001). The discrepancies of the reports were maintained after the separation of the glomerulonephritis in proliferative and non proliferative. Conclusion: The urinary parameters used in characterization of the origin of the hematuria were more frequently identified by the nephrologist, and suggest that the urinalysis, a simple and very informative test, should be mandatory in programs of training in nephrology.