Escala de Calidez en Enfermería (ECAE): construcción y validación empírica / Escala de Calor Humano em Enfermagem (ECHE): construção e validação empírica / Nursing Warmth Scale (NWS): Development and empirical validation

Objetive: To construct and validate the Nursing Warmth Scale (NWS) through the development of a standardized measurement of nurses' warmth, perceived from the perspective of patients, and identify the behaviors and factors associated with this feeling of warmth. Materials and methods: The NWS was developed following the scale construction methodology under a triphasic model. The construction of items was elaborated based on the results of a previously published integrative review that consolidated the construct and the related variables. A qualitative phase was also incorporated to evaluate the latent variable. Content validity was assessed with 10 expert judges. An item try-out was conducted with 476 patients in health institutions. Exploratory factor analysis ­through the common factor method and oblique rotation­ was used for the item reduction process. Results: The construct "Nursing Warmth" was established after the theoretical and empirical phases of the study. The literature review and interviews with 23 patients and 25 nursing professionals provided a set of behaviors divided into 2 categories: verbal and nonverbal behaviors. Exploratory factor analysis allowed identifying 5 factors and 35 items. The reliability was estimated through Cronbach's alpha. The identified factors are: F1-Nonverbal connection-relationship with the other (0.943), F2-Empathy (0.909), F3-Verbal connection-relationship with the other (0.914), F4-Inclusion (0.858), and F5-Confidence (0.852). The Tucker-Lewis Index was 0.901. Conclusions: The NWS demonstrates evidence of reliability and validity. This tool may be useful in clinical settings and for teaching and research addressing interpersonal nursing skills.

Objetivo: construir y validar la Escala de Calidez de Enfermería (ECAE) mediante el desarrollo de una medida estandarizada de la calidez de la enfermería desde la perspectiva de los pacientes, además de identificar los comportamientos y factores asociados con la calidez. Materiales y métodos: la ECAE fue desarrollada según la metodología de construcción de escalas y empleando un modelo trifásico. La construcción de ítems se elaboró con los resultados de una revisión integrativa previamente publicada, que consolidó el constructo y las variables relacionadas. Se incorporó además una fase cualitativa con el fin de evaluar la variable latente. La validez de contenido fue testeada con 10 jueces expertos. Se realizó la validación de los ítems con 476 pacientes de instituciones de salud. Para el proceso de reducción de ítems se utilizó el análisis factorial exploratorio, mediante el método de factores comunes y rotación oblicua. Resultados: luego de las fases teórica y empírica del estudio, se estableció el constructo "Calidez en Enfermería". La revisión de la literatura y las entrevistas a 23 pacientes y 25 profesionales en enfermería proporcionaron un conjunto de comportamientos divididos en dos categorías: conductas verbales y conductas no verbales. El análisis factorial exploratorio identificó 5 factores y 35 ítems. La confiabilidad se estimó con Alfa de Cronbach. Los factores identificados son: F1-Conexión no verbal (0,943), F2-Empatía (0,909), F3-Conexión verbal (0,914), F4-Inclusión (0,858) y F5-Confianza (0,852). El índice de Tucker-Lewis fue de 0,901. Conclusiones: la ECAE demuestra evidencias de confiabilidad y validez. Esta herramienta puede ser útil en el ámbito clínico y en la enseñanza e investigación de habilidades interpersonales en Enfermería.

Objetivo: construir e validar a Escala de Calor Humano em Enfermagem (ECHE) mediante o desenvolvimento de uma medida padronizada do calor humano da enfermagem sob a perspectiva dos pacientes, além de identificar os comportamentos e fatores associados com o calor humano. Materiais e métodos: a ECHE foi desenvolvida de acordo com a metodologia de construção de escalas e utilizando um modelo trifásico. A construção dos itens foi elaborada com os resultados de uma revisão integrativa publicada previamente, que consolidou o construto e as variáveis relacionados. Uma fase qualitativa também foi incorporada para avaliar a variável latente. A validade do conteúdo foi testada com 10 juízes especialistas. Os itens foram validados com 476 pacientes de instituições de saúde. Para o processo de redução de itens, foi utilizada a análise fatorial exploratória por meio do método fatorial comum e da rotação oblíqua. Resultados: após as fases teórica e empírica do estudo, foi estabelecido o construto "calor humano em enfermagem". A revisão da literatura e as entrevistas com 23 pacientes e 25 profissionais de enfermagem forneceram um conjunto de comportamentos divididos em duas categorias: comportamentos verbais e não verbais. A análise fatorial exploratória identificou cinco fatores e 35 itens. A confiabilidade foi estimada com o alfa de Cronbach. Os fatores identificados são F1-Conexão não verbal (0,943), F2-Empatia (0,909), F3-Conexão verbal (0,914), F4-Inclusão (0,858) e F5-Confiança (0,852). O índice de Tucker-Lewis foi de 0,901. Conclusões: a ECHE demonstra evidência de confiabilidade e validade. Essa ferramenta pode ser útil no cenário clínico e no ensino e pesquisa de habilidades interpessoais em Enfermagem.

O uso da exposição gradual para a crença de medo da dor e evitação do movimento em pacientes com lombalgia crônic / Graded exposure for fear of pain and movement avoidance belief in chronic low back pain patients

RESUMO JUSTIFICATIVA E OBJETIVOS: Medo da dor e evitação do movimento é uma crença que contribui para o aumento da incapacidade e alterações do humor em pacientes com lombalgia crônica. A exposição é uma técnica utilizada para essa crença, porém ainda não há um consenso sobre a melhor forma de executá-la em pacientes com lombalgia. O objetivo deste estudo foi analisar o uso da exposição gradual para a crença de medo da dor e evitação do movimento em pacientes com lombalgia crônica. CONTEÚDO: Para busca da literatura analisaram-se as bases e bancos de dados Pubmed, PsycInfo, Web of Science, Cinahl e LILACS, no período entre 2000 e 2015. Critérios de elegibilidade foram estabelecidos para seleção dos estudos. Os estudos foram selecionados primeiramente a partir do título e resumo. Em seguida foram lidos na íntegra. Resultaram da busca bibliográfica 91 estudos. Destes, 38 foram selecionados para a leitura na íntegra. Entre os selecionados, 10 foram excluídos após leitura na íntegra e 19 estavam repetidos. Aplicando-se os critérios de elegibilidade, restaram 9 estudos, que foram incluídos: quatro são estudos antes e depois, um relato de casos, um é estudo quase experimental e três são ensaios clínicos randomizados. CONCLUSÃO: A maioria dos estudos desta revisão comparou exposição ao vivo com atividade gradual, porém não especificam como foram realizadas. Ainda não há clareza sobre as vantagens ou métodos de como realizar a exposição gradual em pacientes com lombalgia, necessitando de maiores estudos de intervenção sobre o tema.

ABSTRACT BACKGROUND AND OBJECTIVES: Fear of pain and movement avoidance is a belief contributing to increase disability and mood changes in chronic low back pain patients. Exposure is a technique used for such belief, however there is still no consensus about the best way to perform it in low back pain patients. This study aimed at evaluating graded exposure for fear of pain and movement avoidance belief in chronic low back pain patients. CONTENTS: The following databases were queried for the period from 2000 to 2015: Pubmed, PsycInfo, Web of Science, Cinahl and LILACS. Eligibility criteria were established for studies selection. Studies were first selected by title and abstract. Then they were read in full. The search has resulted in 91 studies. From these, 38 were selected to be read in full. Among selected studies, 10 were excluded and 19 were repeated. Applying eligibility criteria, nine studies were included: for are before and after studies, one is a case report, one is a quasi-experimental study and three are randomized clinical trials. CONCLUSION: Most studies of this review have compared in vivo exposure and graded activity, however they have not specified how this was done. There is still no clarity about the advantages or methods to perform graded exposure in low back pain patients and further intervention studies on the subject are needed.

[Distress of cancer patients: prevalence and associated factors in the opinion of family]. / Distress do paciente oncológico: prevalência e fatores associados na opinião de familiares.

The study aimed to verify the opinion of family members about distress on cancer patients and the factors associated with it. Interviews with 140 family members of cancer patients were conducted. The Distress Thermometer was adapted to be used with family members. Approximately 72.9% of patients were considered in distress, related to concern (80.4%), nervousness (78.4%), sadness (74.5%), pain (67.6%), fatigue (67.6%) and problems with eating (57.8%). The hierarchical logistic regression models showed that while male (OR=0.025) and older ages (OR=0.006 to 0.059) had lower risk of perceiving the distress, individuals Protestants, compared to Catholics, were 12.77 times more likely to perceive it. About the associated factors, nervousness (OR=10.8) contributed significantly more to the perception of distress for family members when compared to fatigue (OR=3.38) or have private health insurance (OR=2.55). Family can be great allies in the evaluation and monitoring of distress in patients with cancer.

Distress do paciente oncológico: prevalência e fatores associados na opinião de familiares / Distress of cancer patients: prevalence and associated factors in the opinion of family / Angustia de los pacientes con cáncer: prevalencia y factores asociados en la opinión de la familia

Este estudo verificou a prevalência e fatores associados ao distress de pacientes oncológicos, na opinião de familiares. Foram entrevistados 140 familiares responsáveis pelo cuidado de pacientes com câncer. O Termômetro de Distress foi adaptado para uso em familiares. Estes consideraram que 72,9% dos pacientes estavam com distress relacionado a preocupações (80,4%), nervosismo (78,4%), tristeza (74,5%), dor (67,6%), fadiga (67,6%) e problemas com alimentação (57,8%). Modelos de regressão logística hierárquica mostraram que, enquanto familiares do sexo masculino (OR=0,025) e idades mais avançadas (OR=0,006 a 0,059) tiveram menor risco de perceber o distress, indivíduos protestantes, comparados a católicos, tiveram chance 12,77 vezes maior de percebê-lo. Quanto aos fatores associados, nervosismo (OR=10,8) contribuiu significativamente mais com a percepção de distress pelos familiares quando comparado a fadiga (OR=3,38) ou ter plano de saúde privado (OR=2,55). Familiares podem ser grandes aliados na avaliação e acompanhamento do distress de pacientes com câncer.

The study aimed to verify the opinion of family members about distress on cancer patients and the factors associated with it. Interviews with 140 family members of cancer patients were conducted. The Distress Thermometer was adapted to be used with family members. Approximately 72.9% of patients were considered in distress, related to concern (80.4%), nervousness (78.4%), sadness (74.5%), pain (67.6%), fatigue (67.6%) and problems with eating (57.8%). The hierarchical logistic regression models showed that while male (OR=0.025) and older ages (OR=0.006 to 0.059) had lower risk of perceiving the distress, individuals Protestants, compared to Catholics, were 12.77 times more likely to perceive it. About the associated factors, nervousness (OR=10.8) contributed significantly more to the perception of distress for family members when compared to fatigue (OR=3.38) or have private health insurance (OR=2.55). Family can be great allies in the evaluation and monitoring of distress in patients with cancer.

Este estudio examinó la prevalencia y los factores asociados con el distress de los pacientes de cáncer, de acuerdo con los familiares. Fueran entrevistados 140 cuidadores familiares de pacientes con cáncer. El Termómetro de Distress fue adaptado para el uso en los familiares. Ellos encontraron que el 72,9% de los pacientes estaban con distress relacionado con preocupaciones (80,4%), nerviosismo (78,4%), tristeza (74,5%), dolor (67,6%), fatiga (67, 6%) y problemas con la alimentación (57,8%). Modelos de regresión logística jerárquica mostraran que, mientras los familiares de sexo masculino (OR=0,025) y de edades más avanzadas (OR=0,006 a 0,059) tuvieron un menor riesgo de percibir el distress, los individuos protestantes, comparados a los católicos, tuvieron oportunidad 12,77 veces mayor para percibirlo. En cuanto a los factores asociados, el nerviosismo (OR=10,8) contribuyó significativamente más a la percepción del distress de los familiares, en comparación con la fatiga (OR=3,38) o tener un seguro de salud privado (OR=2,55). Familiares pueden ser grandes aliados en la evaluación y el seguimiento de sufrimiento en los pacientes con cáncer.

Racial discrimination in pain management / A discriminação racial no tratamento da dor

BACKGROUND AND OBJECTIVES: The vulnerability of certain races and ethnicities may be worsened by the subjectivity of pain. So, this study aimed at identifying whether there has been racial discrimination in pain control by health professionals. CONTENTS: This is a literature review and queried databases were: PubMed/Medline, LILACS, SciELO, Cochrane, EMBASE, SCOPUS and psycINFO with keywords in English and Portuguese: pain-dor andrace-raça orethnic-etnia, analgesia-analgesia, prejudice/discrimination-discriminação, prescriptions drug-prescrição médica. From 3216 articles, 45 were selected. Five were included after manual search, in a total of 50 articles. CONCLUSION: No study was carried out in Brazil and 96% are from the United States. Studies are of the cross sectional and cohort type. Most researched races/ethnicities were black and white, followed by Hispanic and Asian. Most common outcomes were: access to treatment and analgesic prescription. Racial discrimination was identified in 74% of studies, being blacks the most discriminated race...

JUSTIFICATIVA E OBJETIVOS: A vulnerabilidade de determinadas raças e etnias, pode ser agravada pela subjetividade da dor. Portanto, o objetivo deste estudo foi identificar se há discriminação racial no controle da dor pelos profissionais de saúde. CONTEÚDO: Trata-se de uma revisão de literatura, e as bases de dados consultadas foram: PubMed/Medline, LILACS, SciELO, Cochrane, EMBASE, SCOPUS e psycINFO com palavras-chaves em inglês e português: pain-dor and race-raça or ethnic-etnia, analgesia-analgesia, prejudice/discrimination-discriminação, prescriptions drug-prescrição médica. De 3.216 artigos, 45 foram selecionados. Na busca manual, cinco foram incluídos, totalizando 50 artigos. CONCLUSÃO: Nenhum estudo foi realizado no Brasil e 96% são dos Estados Unidos. Os estudos são do tipo transversal e corte. As raças/etnias mais pesquisadas foram a negra e a branca, seguidas dos hispânicos e asiáticos. Os desfechos mais usados foram: acesso ao tratamento e a prescrição de analgésicos. A discriminação racial foi identificada em 74% dos estudos, sendo a raça negra a mais discriminada...

[Association between chronic pain and self-reported falls in the SABE study population]. / Associação entre dor crônica e autorrelato de quedas: estudo populacional ? SABE.

The objective of this study was to assess the association between chronic pain and self-reported falls. This was a cross-sectional sample of elderly individuals without cognitive deficits, living in the city of São Paulo, Brazil, and with chronic pain. The study considered elderly that reported chronic pain for at least one year. History of falls was defined as at least one reported fall in the 12 months prior to the study. Data were obtained by home surveys of the elderly. Stata 11.0 was used for statistical analysis. Prevalence of chronic pain was 29.7% (95%CI: 25.4-33.9). Prevalence of falls in the previous year for individuals with pain was 31.6% (95%CI: 26.4-37.5) and did not differ significantly from those without pain (26.4%; 95%CI: 23.1-30.0; p = 0.145). Risk of falls was 50% higher (p = 0.019) for those with pain and osteoporosis and 48% higher for those with pain and urinary incontinence (p = 0.010). History of pain for at least one year and osteoporosis, pain, and urinary incontinency showed higher odds of falls.

Associação entre dor crônica e autorrelato de quedas: estudo populacional ? SABE / Association between chronic pain and self-reported falls in the SABE study population / Asociación entre dolor crónico y auto-reporte de las caídas: estudio poblacional ? SABE

Estudo populacional transversal com idosos sem déficit cognitivo residentes na cidade de São Paulo, Brasil. O objetivo foi avaliar a associação entre dor crônica e autorrelato de quedas. Idoso com dor crônica foi considerado aquele com dor de duração há mais de um ano. Os dados foram coletados por entrevista domiciliar, e as análises foram realizadas no programa Stata 11.0. A prevalência de dor crônica foi 29,7% (IC95%: 25,4-33,9); a prevalência de queda, no último ano, entre idosos com dor foi 31,6% (IC95%: 26,4-37,5) e não diferiu da prevalência entre idosos sem dor (26,4%; IC95%: 23,1-30,0; p = 0,145). No entanto, quando havia dor e osteoporose ou dor e incontinência urinária, o risco de quedas foi 50% (p = 0,019) e 48% maior (p = 0,010), respectivamente. A associação dor crônica e osteoporose ou incontinência urinária elevou a chance de quedas em idosos.

The objective of this study was to assess the association between chronic pain and self-reported falls. This was a cross-sectional sample of elderly individuals without cognitive deficits, living in the city of São Paulo, Brazil, and with chronic pain. The study considered elderly that reported chronic pain for at least one year. History of falls was defined as at least one reported fall in the 12 months prior to the study. Data were obtained by home surveys of the elderly. Stata 11.0 was used for statistical analysis. Prevalence of chronic pain was 29.7% (95%CI: 25.4-33.9). Prevalence of falls in the previous year for individuals with pain was 31.6% (95%CI: 26.4-37.5) and did not differ significantly from those without pain (26.4%; 95%CI: 23.1-30.0; p = 0.145). Risk of falls was 50% higher (p = 0.019) for those with pain and osteoporosis and 48% higher for those with pain and urinary incontinence (p = 0.010). History of pain for at least one year and osteoporosis, pain, and urinary incontinency showed higher odds of falls.

El objetivo de este estudio fue evaluar la asociación entre dolor crónico y el auto-reporte de las caídas. Estudio transversal, de base poblacional de personas de edad avanzada sin déficit cognitivo, residentes en la ciudad de São Paulo, Brasil. Los ancianos con dolor crónico lo definen como un dolor prolongado durante hace más de un año. Los datos fueron recogidos mediante entrevistas y los análisis se realizaron utilizando Stata 11.0. La prevalencia de dolor crónico fue de 29,7 % (IC95%: 25,4-33,9), la prevalencia de caídas en el último año, entre las personas de edad avanzada con dolor fue de 31,6% (IC95%: 26,4-37,5) y no difieren de las personas de edad avanzada sin dolor (26,4%; IC95%: 23,1-30,0; p = 0,145). Sin embargo, cuando existía dolor y se sufría osteoporosis o existía dolor e incontinencia urinaria, el riesgo de caídas fue de 50% (p = 0,019) y 48% (p = 0,010), respectivamente. La asociación dolor crónico y la osteoporosis o incontinencia urinaria aumenta la posibilidad de caídas en el anciano.

Associacao de dor cronica com uso de servicos de saude em idosos residentes em Sao Paulo / Asociacion de dolor cronico con uso de servicios de salud en ancianos residentes en Sao Paulo, Brasil. / Association of chronic pain with the use of health care services by older adults in Sao Paulo

OBJETIVO Analisar a associação entre a utilização de serviço de saúde por idosos com dor crônica e variáveis sociodemográficas e de saúde. MÉTODOS Estudo transversal com amostra populacional realizado por meio de inquérito domiciliar em São Paulo, SP, em 2006, com 1.271 idosos de 60 anos ou mais, sem déficit cognitivo, que relataram dor crônica. Dor crônica foi definida como aquela com duração ≥ 6 meses. O critério para uso do serviço de saúde foi ter feito mais de quatro consultas ou uma internação no último ano. Para os idosos com dor há pelo menos um ano, testou-se a existência de associação entre uso do serviço de saúde com as variáveis independentes (características da dor, sociodemográficas e doenças autorreferidas), por meio de análises univariadas (teste de Rao & Scott) e múltiplas (Regressão Múltipla de Cox com variância robusta). Utilizou-se o programa Stata 11.0 e adotou-se como valor de significância p < 0,05. RESULTADOS A prevalência de utilização do serviço de saúde nos idosos com dor foi 48,0% (IC95% 35,1;52,8) e não diferiu dos idosos sem dor (50,5%; IC95% 45,1;55,9). A chance de utilização do serviço de saúde foi 33,0% menor nos idosos com dor há mais de dois anos do que naqueles com dor entre um e dois anos (p = 0,002); 55,0% maior nos idosos com dor intensa (p = 0,003) e 45,0% maior entre os que relataram interferência moderada da dor no trabalho (p = 0,015) na análise múltipla. CONCLUSÕES A dor crônica foi frequente e esteve associada a maiores prejuízos na independência e mobilidade. A dor crônica mais intensa, a mais recente e a com impacto no trabalho resultaram em maior uso dos serviços de saúde. .

OBJETIVO Analizar la asociación entre la utilización de servicio de salud por ancianos con dolor crónico y variables sociodemográficas y de salud. MÉTODOS Estudio transversal con muestra poblacional realizado por medio de pesquisa domiciliar en Sao Paulo, SP-Brasil, en 2006, con 1.271 ancianos de 60 años o más, sin déficit cognitivo, que manifestaron dolor crónico. Dolor crónico fue definido como aquel con duración ≥ 6 meses. El criterio para uso del servicio de salud fue haber tenido más de cuatro consultas o una internación en el último año. Para los ancianos con dolor por al menos un año, se evaluó existencia de asociación entre uso del servicio de salud con las variables independientes (características del dolor, sociodemográficas y enfermedades auto-referidas), por medio de análisis univariados (prueba de Rao & Scott ) y múltiples (Regresión Múltiple de Cox con varianza robusta). Se utilizó el programa Stata 11.0 y se adoptó como valor de significancia p<0,05. RESULTADOS La prevalencia de utilización del servicio de salud en los ancianos con dolor fue 48,0% (IC 95% 35,1;52,8), y no difirió de los ancianos sin dolor (50,5%; IC95% 45,1;55,9). El porcentaje de utilización del servicio de salud fue 33,0% menor en los ancianos con dolor por más de dos años que en aquellos con dolor entre uno y dos años (p=0,002); 55,0% mayor en los ancianos con dolor intenso (p=0,003) y 45% mayor entre los que manifestaron interferencia moderada del dolor (p=0,015) en el análisis múltiple. CONCLUSIONES El dolor crónico fue frecuente y estuvo asociado a mayores perjuicios en la independencia y movilidad. El dolor crónico más intenso, el más reciente y con impacto en el trabajo resultaron en mayor uso de los servicios de salud. .

OBJECTIVE Evaluate the association between use of health care services by older adults with chronic pain and sociodemographic and health variables. METHODS Cross-sectional study whose population sample of 1,271 older adults with chronic pain and with no cognitive deficit was obtained through home surveys in Sao Paulo, SP, Southeastern Brazil,, in 2006. The study considered pain lasting for six or more months as chronic. The criterion for health care service use was more than four doctor appointments or having been admitted to a hospital during the past year. For those in chronic pain for at least one year, the existence of an association between the use of health care services and independent variables (pain and socio-demographical characteristics and self-reported morbidities) was tested using univariate (RaoScott test of association) and multivariate analysis (Cox Multiple Regression with robust variance). Stata 11.0 was used for the statistical analysis, and the significance level adopted was p < 0.05. RESULTS The prevalence of health care service use among older people with pain was 48,0% (95%CI 35.1;52.8) and did not differ from older adults without chronic pain (50.5%, 95%CI 45.1;55.9). The multivariate analysis showed that the chance of using health care services was 33,0% lower for older adults with pain for more than two years than those with pain between one and two years (p = 0.002). The chance was 55,0% higher for those with intense pain (p = 0.003) and 45,0% higher for those with moderate pain interference in the work (p = 0.015). CONCLUSIONS Chronic pain was found to be common and was associated with negative effects on independence and mobility. More intense and recent chronic pain that affected work resulted in greater use of health care services. .

['Sandwich PhD': considerations for a successful experience abroad]. / Doutorado sanduíche: considerações para uma experiência de sucesso no exterior.

International PhD internship, named "Sandwich PhD" in Brazil is an opportunity to improve research abilities, to become known in academic area and to establish and/or increase work opportunities in an international context. In this article, we describe key factors regarding the planning and development of the "Sandwich PhD" as experienced by professors and students involved in the collaboration between the School of Nursing, University of São Paulo and Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada. We also present the participation of PhD students' network as an alternative to the "Sandwich PhD". An international experience, when well-planned and developed correctly, promotes students' personal and professional development and favors the internationalization of Brazilian graduate programs and research groups.

Chronic pain and quality of life in schizophrenic patients.

OBJECTIVE: To identify the prevalence and characteristics of chronic pain in schizophrenic patients and to compare the quality of life in patients with and without chronic pain. METHODS: Crossover design with a probablistic sample of 205 adult schizophrenic outpatients (80% paranoid schizophrenia). Socio-demographic, psychiatric disorder, pain and quality of life (WHOQOL- brief) data were collected between June and September 2008. RESULTS: Mean age was 37 years, 65% were men, and the mean time spent in school was 9 years; 87% were single, 65% lived with parents and 25% had a job. Among patients with chronic pain, 70% did not receive treatment for pain. Regarding quality of life, patients with pain had more physical disabilities compared to those without pain (p < .001). There were no differences in other domains. Comparisons between patients with and without pain did not show any differences in how much they felt their mental health problems disabled them. CONCLUSION: Chronic pain was common in schizophrenic patients (similar to the general population of a similar age) and decreased their quality of life. It is necessary to pay more attention to this co-morbidity.

[Pain assessment and training: the impact on pain control after cardiac surgery]. / Treinamento e avaliação sistematizada da dor: impacto no controle da dor do pós-operatório de cirurgia cardíaca.

We analyzed the effects of training and the application of a form for the systematized assessment of pain control after cardiac surgery on pain intensity and supplementary use of morphine. Three patient groups underwent a non-randomized clinical trial with standardized analgesic prescription. In Group I, the nursing staff did not receive specific training regarding the assessment and management of pain, and patients were treated following the established protocol of the institution. In Groups II and III, the nursing staff received targeted training. In Group II the nursing staff used a form for the systematized assessment of pain, which was not used in Group III. Group II presented a lower intensity of pain and greater consumption of supplementary morphine compared to Groups I and II. Training associated with the systematized assessment form increased the chance of identifying pain and influenced nurses' decision-making process, thus promoting pain relief among patients.

[Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and association with functional capacity and mobility (SABE Study)]. / Dor crônica em idosos residentes em São Paulo, Brasil: prevalência, características e associação com capacidade funcional e mobilidade (Estudo SABE).

The objective was to identify the prevalence and characteristics of chronic pain and the association with functional capacity. This was a cross-sectional study with a population sample of community-dwelling elderly residents in the city of São Paulo, Brazil, using home interviews. Statistical analysis used the RaoScott test of association with p < 0.05. Prevalence of chronic pain was 29.7% (95%CI: 25.4-33.9), most frequent in the lower back (25.4%) and lower limbs (21.9%), and moderate in 45.8% and intense in 46% of the sample. Chronic pain was associated with increased dependence and decreased mobility (p < 0.001).

Prevalence of fatigue and associated factors in chronic low back pain patients.

OBJECTIVES: to determine the prevalence and key factors associated with fatigue in chronic low back pain patients. METHODS: cross-sectional study of 215 chronic low back pain patients from three health care centers and two industrial corporations. The crude prevalence of fatigue and its 95% confidence interval (CI) were calculated. Associations between fatigue and the independent variables were measured. RESULTS: the prevalence of fatigue among the participants was 26.0% [95% CI: 20.3-32.5]. Fatigue was independently associated with depression and self-efficacy. An increase of one unit in the score of depression increased the risk of fatigue by 9%; an increase of one unit in the score of self-efficacy reduced the risk of fatigue by 2%. CONCLUSIONS: fatigue was prevalent in chronic low back pain patients and associated with depression and self-efficacy. Knowing these factors can direct strategies for prevention and control of fatigue in chronic low back pain patients.

Doutorado sanduíche: considerações para uma experiência de sucesso no exterior / Doctorado sándwich: consideraciones para una experiencia exitosa en el extranjero / 'Sandwich PhD': considerations for a successful experience abroad

O estágio de doutorado no exterior, conhecido, no Brasil, como "Doutorado Sanduíche", é uma oportunidade de aprimorar as habilidades em pesquisa, destacar-se no meio acadêmico e estabelecer e/ou ampliar oportunidades de trabalho em contexto internacional. Neste artigo, descrevemos elementos-chave do processo de planejamento e desenvolvimento do Doutorado Sanduíche aprendidos por professores e alunos envolvidos na colaboração entre a Escola de Enfermagem da Universidade de São Paulo e a Lawrence S. Bloomberg Faculty of Nursing, Universidade de Toronto, Canadá, e apresentamos a participação em uma rede de doutorados, como alternativa ao Doutorado Sanduíche. A experiência internacional, quando bem planejada e desenvolvida, promove o desenvolvimento pessoal e profissional do aluno, favorece a internacionalização dos programas de pós-graduação e dos grupos de pesquisa brasileiros.

Una estancia de doctorado internacional, "Doctorado Sándwich" como es conocido en Brasil, es una oportunidad de mejorar las habilidades de investigación, hacerse conocido académicamente y establecer y/o agrandar las oportunidades de trabajo en el contexto internacional. En este artículo, nosotros describimos factores importantes del proceso de la planificación y desarrollo del "Doctorado Sándwich" aprendidos por estudiantes y profesores involucrados en la colaboración entre la Escuela de Enfermería de la Universidad de São Paulo y la Facultad de Enfermería Lawrence S. Bloomberg, Universidad de Toronto, Canadá y presentamos la participación en una red de doctorados como una alternativa a la estancia doctoral internacional. La experiencia internacional, cuando bien planeada y desarrollada, promueve el desarrollo personal y profesional del estudiante y favorece la internacionalización de los programas de postgrado y de los grupos de investigación brasileños.

International PhD internship, named "Sandwich PhD'" in Brazil, is an opportunity to improve research abilities, to become known in academic area and to establish and/or increase work opportunities in an international context. In this article, we describe key factors regarding the planning and development of the "Sandwich PhD" as experienced by professors and students involved in the collaboration between the School of Nursing, University of São Paulo and Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada. We also present the participation of PhD students' network as an alternative to the "Sandwich PhD". An international experience, when well-planned and developed correctly, promotes students' personal and professional development and favors the internationalization of Brazilian graduate programs and research groups.

Chronic pain and quality of life in schizophrenic patients

OBJECTIVE: To identify the prevalence and characteristics of chronic pain in schizophrenic patients and to compare the quality of life in patients with and without chronic pain. METHODS: Crossover design with a probablistic sample of 205 adult schizophrenic outpatients (80% paranoid schizophrenia). Socio-demographic, psychiatric disorder, pain and quality of life (WHOQOL- brief) data were collected between June and September 2008. RESULTS: Mean age was 37 years, 65% were men, and the mean time spent in school was 9 years; 87% were single, 65% lived with parents and 25% had a job. Among patients with chronic pain, 70% did not receive treatment for pain. Regarding quality of life, patients with pain had more physical disabilities compared to those without pain (p < .001). There were no differences in other domains. Comparisons between patients with and without pain did not show any differences in how much they felt their mental health problems disabled them. Conclusion: Chronic pain was common in schizophrenic patients (similar to the general population of a similar age) and decreased their quality of life. It is necessary to pay more attention to this co-morbidity.