Emotional distress in haemophilia: Factors associated with the presence of anxiety and depression symptoms among adults.

INTRODUCTION: Haemophilia is related to several clinical and psychosocial challenges that have been associated with increased emotional distress. These may impact on disease adjustment and health outcomes, reinforcing the attention given to psychosocial health of people with haemophilia (PWH), in the scope of optimal comprehensive care. AIM: To identify potentially modifiable factors associated with the presence of anxiety and depression symptoms among adult PWH. METHODS: This was a cross-sectional observational study examining socio-demographic, clinical and psychosocial variables among 102 patients with haemophilia A or B who participated on a mail survey of haemophilia in Portugal. RESULTS: People with haemophilia revealing higher anxiety and depression symptoms were more likely to have had, in the previous year, more urgent hospital visits due to haemophilia, more bleeding episodes, more affected joints and pain, as well as worst levels of perceived functionality and quality of life. After controlling for demographic (age and education) and clinical (haemophilia severity and joint deterioration) variables in multivariate hierarchical logistic regression analyses, professional status (OR = 4.646, P = .004; OR = 3.333, P = .029) and pain interference (OR = 1.397, P = .011; OR = .1.347, P = .037) were significantly associated with both anxiety and depression symptoms. Additionally, physical activity (OR = 0.302, P = .024) and the perception of consequences underlying haemophilia (OR = 1.600, P = .012) also emerged as key factors significantly associated with depression symptoms. CONCLUSION: Current findings increased knowledge on factors associated with anxiety and depression among PWH. These highlight potential intervention targets, which are amenable to change through evidence-based tailored interventions aiming to decrease emotional distress, promote well-being and improving haemophilia-related health outcomes among these patients.

Pre- and post-surgical factors that predict the provision of rescue analgesia following hysterectomy.

BACKGROUND: To better manage post-surgical pain, standardized analgesic protocols allow for rescue analgesia (RA). This study seeks to determine which pre- and post-surgical clinical and patient-related factors, in addition to post-surgical pain, may influence health care professional decisions on RA administration. METHODS: A consecutive sample of 185 women, submitted to hysterectomy for benign disorders, was assessed 24 h before (time 1; T1) and 48 h after (time 2; T2) surgery. At T1, baseline demographic, clinical and psychological predictors were assessed and at T2, post-surgical pain, anxiety and RA administration were recorded. RESULTS: After controlling for post-surgical acute pain intensity, logistic regression results revealed several pre-surgical (T1) and surgical factors associated with post-surgical RA: having other previous pain states [odds ratio (OR), 4.551; 95% confidence interval (CI), 1.642-12.611, p = 0.004], being anaesthetized with only general or loco-regional anaesthesia (OR, 5.349; 95% CI, 1.976-14.483, p = 0.001) and pre-surgical fear of immediate consequences of surgery (OR, 1.306; 95% CI, 1.031-1.655, p = 0.027). Concerning post-surgical variables, higher pain intensity (OR, 1.591; 95% CI, 1.353-1.871, p < 0.001) and post-surgical anxiety (OR, 1.245; 95% CI, 1.084-1.430, p = 0.002) were significantly associated with RA provision. CONCLUSIONS: Health care decision making to administer RA might be influenced not only by post-surgical pain intensity but also by pre-surgical and surgical clinical factors, such as previous pain and type of anaesthesia. Patient-related psychological characteristics, such as pre-surgical fear and post-surgical anxiety, may also play a role in decision making on RA provision. Implications for practice are discussed.

Confiabilidade de um modelo de avaliação para portadores de LER/DORT: a experiencia de um servico público de saúde / Reliability of an assessment model for patients with RSI/WRMDS: the experience of a public healthcare service

Lesoes por esforcos repetitivos (LER) ou disturbios osteomusculares relacionados ao trabalho (DORT) reunem um cnjunto de afeccoes musculoesqueleticas que muitas vezes apresentam dificil tratamento. Difrentes abordagens terapeuticas vem sendo oferecidas pelos servicos de saude e a necessidade de avalia-las torna essencial a adocao de instrumentos de avaliacao adequados. Objetivo: testar a confiabilidade interobservadores do exame fisico e verificar a correlacao entre os achados fisicos e a capacidade funcional dos pacientes avaliados. Metodo A ficha de avaliacao proposta foi aplicada a 25 portadores de LER/DORT e incluiu criterios classicos da avaliacao fisioterapeutica, indice de amplitude articular para a mensuracao funcional das amplitudes de movimento (ADM) e um questionario sobre atividades de vida diaria. A concordancia dos examinadores para os testes especiais foi analisada por meio de coeficiente de Spearman. Resultados verificou-se boa confiabilidade interobservadores para os testes especiais, exceto para o teste de Adson modificado, e para as mensuracoes da ADM. Correlacao moderada foi observada entre os achados fisicos e o grau de capacidade funcional. Conclusoes O modelo de avaliacao proposto reune testes especiais confiaveis, com excecao do teste de adson modificado, mensuracao de ADM mais rapidas em razoes do uso de estimativa visual e uma analise funcional que complementa oa achados do exame fisico, possibilitando avaliacao mais abrangente dos pacientes com dor cronica

A computer simulation designed for problem-based learning.

OBJECTIVES: As problem-based learning is increasingly used in medical education, there is a growing need to capture the diversity of the events occurring during problem-based learning sessions in order to understand the way in which students learn. The computer simulation described attempts to analyse a posteriori how students reason and learn during such sessions. DESIGN: A computer simulation was designed to perform a detailed analysis of the following features: pattern of information searched, formulation of working hypothesis and identification of learning issues. The program, which has been running successfully for 2 years, was developed using local resources and accepts any clinical problem, provided it is written in a suitable text file format. The program has been applied in the discipline of pathophysiology. SETTING: Faculty of Medical Sciences of Lisbon, Portugal. SUBJECTS: Medical students. RESULTS: An example is presented of how prints were analysed in order to evaluate the 'progression profile' of the students, and a comparison is made with other similar instruments. CONCLUSIONS: The program improved understanding of the relationships between the inquiry strategy and hypothesis formulation and also of how self-learning (triggered by learning issues) influenced further analysis of the cases.

[Applications of problem-based learning in the basic medical curriculum]. / Aplicações da aprendizagem por problemas no ciclo básico do curso de medicina.

This article describes a project, which took place between 1992 and 1994, on the application of problem-based learning to three disciplines of the basic medical curriculum: Biochemistry (1st year) Physiology (2nd year) and physiopathology (3rd year). The main objectives of the project were to bring teaching closer to the future professional reality, to stimulate critical thinking and to facilitate independent learning. Despite differences in content and in teaching materials, the trigger event for learning was information given within a clinical context which was further analyzed in small-group tutorial sessions. The project also included the training of the tutors and the development of audiovisual materials. Although no statistically significant differences were found in the final scores between students taught during this period and before, the first group reported a considerable increase in the motivation to learn which, in the case of Biochemistry, was important to change the passive attitude of most students on entering university. The project also helped to create the appropriate atmosphere for the establishment of an office for medical education in the medical school to support other innovations in the field. With this project we wished to contribute, with a concrete experience, to the reform of medical education in Portugal, by demonstrating that problem-based learning can be used in single disciplines without major changes in the basic curriculum.