Pre-validation Study of the Brazilian Version of the Disruptions in Surgery Index (DiSI) as a Safety Tool in Cardiothoracic Surgery.

INTRODUCTION: Most risk stratification scores used in surgery do not include external and non-technical factors as predictors of morbidity and mortality. OBJECTIVE: The present study aimed to translate and adapt transculturally the Brazilian version of the Disruptions in Surgery Index (DiSI) questionnaire, which was developed to capture the self-perception of each member of the surgical team regarding the disruptions that may contribute to error and obstruction of safe surgical flow. METHODS: A universalist approach was adopted to evaluate the conceptual equivalence of items and semantics, which included the following stages: (1) translation of the questionnaire into Portuguese; (2) back translation into English; (3) panel of experts to draft the preliminary version; and (4) pre-test for evaluation of verbal comprehension by the target population of 43 professionals working in cardiothoracic surgery. RESULTS: The questionnaire was translated into Portuguese and its final version with 29 items obtained 89.6% approval from the panel of experts. The target population evaluated all items as easy to understand. The mean overall clarity and verbal comprehension observed in the pre-test reached 4.48 ± 0.16 out of the maximum value of 5 on the psychometric Likert scale. CONCLUSION: Based on the methodology used, the experts' analysis and the results of the pre-test, it is concluded that the essential stages of translation and cross-cultural adaptation of DiSI to the Portuguese language were satisfactorily fulfilled in this study.

Pre-validation study of the brazilian version of the disruptions in surgery index (disi) as a safety tool in cardiothoracic surgery

Abstract Introduction: Most risk stratification scores used in surgery do not include external and non-technical factors as predictors of morbidity and mortality. Objective: The present study aimed to translate and adapt transculturally the Brazilian version of the Disruptions in Surgery Index (DiSI) questionnaire, which was developed to capture the self-perception of each member of the surgical team regarding the disruptions that may contribute to error and obstruction of safe surgical flow. Methods: A universalist approach was adopted to evaluate the conceptual equivalence of items and semantics, which included the following stages: (1) translation of the questionnaire into Portuguese; (2) back translation into English; (3) panel of experts to draft the preliminary version; and (4) pre-test for evaluation of verbal comprehension by the target population of 43 professionals working in cardiothoracic surgery. Results: The questionnaire was translated into Portuguese and its final version with 29 items obtained 89.6% approval from the panel of experts. The target population evaluated all items as easy to understand. The mean overall clarity and verbal comprehension observed in the pre-test reached 4.48 ± 0.16 out of the maximum value of 5 on the psychometric Likert scale. Conclusion: Based on the methodology used, the experts' analysis and the results of the pre-test, it is concluded that the essential stages of translation and cross-cultural adaptation of DiSI to the Portuguese language were satisfactorily fulfilled in this study.

Psychological criteria for contraindication in lung transplant candidates: a five-year study.

Lung transplantation presents a wide range of challenges for multidisciplinary teams that manage the care of the recipients. Transplant teams should perform a thorough evaluation of transplant candidates, in order to ensure the best possible post-transplant outcomes. That is especially true for the psychologist, because psychological issues can arise at any point during the perioperative period. The objective of our study was to evaluate the psychological causes of contraindication to waiting list inclusion in a referral program for lung transplantation. We retrospectively analyzed data on psychological issues presented by lung transplant candidates, in order to understand these matters in our population and to reflect upon ways to improve the selection process.

Depressive and anxiety symptoms in patients with Metabolic Syndrome / Sintomas de depressão e de ansiedade em pacientes com Síndrome Metabólica

Depressive symptoms have been associated to the Metabolic Syndrome. Nevertheless, only a few studies have evaluated anxiety and depression concomitantly. The objective of the research was to evaluate the intensity of depressive and anxiety symptoms in patients with Metabolic Syndrome and their relation to demographic variables. A unicenter, transversal study was carried out. A social demographic questionnaire was used. Depressive symptoms were measured with Beck Depression Inventory and anxiety symptoms were measured with Hamilton Anxiety Scale Rate. A total of 103 ambulatory patients, 60 of them men, with mean age 55.4 years (±7,6) with a diagnosis of Metabolic Syndrome were included in the study. Anxiety symptoms of very severe intensity were present in 51.5% (n=53) while severe depressive symptoms in only 5.8% (n=6). Anxiety and depressive symptoms were significantly associated. In this sample, anxiety predominated in relation to the depressive symptoms. The anxiety symptoms were more intense in women and that had low level of education.(AU)

Os sintomas depressivos têm sido associados à Síndrome Metabólica. No entanto, poucos estudos avaliam simultaneamente ansiedade e depressão nessa população. A pesquisa teve por objetivo avaliar a intensidade de sintomas depressivos e de ansiedade em pacientes com Síndrome Metabólica, correlacionando-a com variáveis sociodemográficas. Configurou um estudo transversal e unicêntrico. Utilizou-se questionário sociodemográfico, Inventário de Depressão de Beck e Escala de Ansiedade de Hamilton. Participaram 103 pacientes ambulatoriais que apresentaram critérios médicos para a Síndrome Metabólica, selecionados consecutivamente. A idade média foi de 55,37 anos (±7,62), sendo 60 homens. Os sintomas de ansiedade de gravíssima intensidade estiveram presentes em 51,5% pacientes (n=53), enquanto os sintomas depressivos graves estiveram presentes em 5,8% (n=6). Houve correlação positiva e expressiva entre as escalas de depressão e de ansiedade. Concluiu-se que, nesta amostra, os sintomas ansiosos de intensidade grave foram predominantes em relação aos sintomas depressivos, sobretudo entre as mulheres e entre indivíduos com baixa escolaridade.(AU)

Depressive and anxiety symptoms in patients with Metabolic Syndrome / Sintomas de depressão e de ansiedade em pacientes com Síndrome Metabólica

Depressive symptoms have been associated to the Metabolic Syndrome. Nevertheless, only a few studies have evaluated anxiety and depression concomitantly. The objective of the research was to evaluate the intensity of depressive and anxiety symptoms in patients with Metabolic Syndrome and their relation to demographic variables. A unicenter, transversal study was carried out. A social demographic questionnaire was used. Depressive symptoms were measured with Beck Depression Inventory and anxiety symptoms were measured with Hamilton Anxiety Scale Rate. A total of 103 ambulatory patients, 60 of them men, with mean age 55.4 years (±7,6) with a diagnosis of Metabolic Syndrome were included in the study. Anxiety symptoms of very severe intensity were present in 51.5% (n=53) while severe depressive symptoms in only 5.8% (n=6). Anxiety and depressive symptoms were significantly associated. In this sample, anxiety predominated in relation to the depressive symptoms. The anxiety symptoms were more intense in women and that had low level of education...

Os sintomas depressivos têm sido associados à Síndrome Metabólica. No entanto, poucos estudos avaliam simultaneamente ansiedade e depressão nessa população. A pesquisa teve por objetivo avaliar a intensidade de sintomas depressivos e de ansiedade em pacientes com Síndrome Metabólica, correlacionando-a com variáveis sociodemográficas. Configurou um estudo transversal e unicêntrico. Utilizou-se questionário sociodemográfico, Inventário de Depressão de Beck e Escala de Ansiedade de Hamilton. Participaram 103 pacientes ambulatoriais que apresentaram critérios médicos para a Síndrome Metabólica, selecionados consecutivamente. A idade média foi de 55,37 anos (±7,62), sendo 60 homens. Os sintomas de ansiedade de gravíssima intensidade estiveram presentes em 51,5% pacientes (n=53), enquanto os sintomas depressivos graves estiveram presentes em 5,8% (n=6). Houve correlação positiva e expressiva entre as escalas de depressão e de ansiedade. Concluiu-se que, nesta amostra, os sintomas ansiosos de intensidade grave foram predominantes em relação aos sintomas depressivos, sobretudo entre as mulheres e entre indivíduos com baixa escolaridade...

Coronary artery disease and experiences of losses.

BACKGROUND: In literature, depression is associated with cardiovascular diseases. From clinical experience, we observed that the psychological category 'experience of loss' was associated with the onset and development of coronary heart disease. The experience of loss caused by self-reported significant event(s) leads to grief and the psychosocial factors which predispose the patient to diseases. OBJECTIVE: To study the impact of the experience of loss by investigating the relationship between mourning and depression, in hospitalized patients with coronary heart disease. METHODS: 44 inpatients (50% men and 50% women, aged 33 to 65 years), with a diagnosis of acute myocardial infarction or angina, were evaluated. Two instruments were used: a semi-structured interview, for investigating the experience of loss and evaluating the state of grief; and the Beck Depression Inventory, for measuring the severity of depression. The results were expressed using the computer program Statistical Package for Social Sciences version 11.0. RESULTS: 66% of the patients were in mourning, the relationship between mourning and depression was significant (p<0,05), and we verified that 100% of the patients who had serious depression were in mourning. The most frequent self-reported significant event was death of a family member (47%) and death of a close person (13%), totaling 60% of the events, reported by 84% of the participants. According to the results of Beck Depression Inventory, 48% of them had depression. CONCLUSION: This study suggests that the psychological category 'experience of loss' should be used as an indicator of the existence of psychological factors that could predispose the patient to CAD, and also confirms the relationship between a state of mourning and depression.

Doença arterial coronariana e vivência de perdas / Coronary artery disease and experiences of losses

FUNDAMENTO: Na literatura, a depressão aparece associada a doenças cardiovasculares. A partir da experiência clínica, observou-se a categoria vivência de perdas associada à instalação e ao desenvolvimento da coronariopatia. A vivência de perdas, desencadeada por evento(s) significativo(s) apontado(s) pelo paciente, implica em processo de luto, remetendo-o aos fatores psicossociais predisponentes ao adoecer. OBJETIVO: Investigar vivência de perdas por meio da avaliação do estado de luto e de depressão, e verificar a relação entre ambos, em pacientes internados com doença arterial coronariana. MÉTODOS: Avaliaram-se 44 pacientes internados, com os diagnósticos de infarto agudo do miocárdio ou angina, de 33 a 65 anos, 50 por cento homens e 50 por cento mulheres. Foram utilizados dois instrumentos: entrevista semi-estruturada para investigação de vivência de perdas e avaliação do estado de luto, e inventário de depressão de Beck para avaliação de depressão. Os resultados foram relacionados pelo programa Statistical Package for Social Sciences, versão 11.0. RESULTADOS: O estado de luto pode ser identificado em 66 por cento dos casos, com significativa relação entre luto e depressão (p < 0,05). Observou-se ainda que 100 por cento das pessoas com depressão grave apresentam luto. O evento significativo referido com mais frequência foi morte de familiares (47 por cento) e de pessoa próxima (13 por cento), totalizando 60 por cento dos eventos relatados por 84 por cento dos participantes. De acordo com os resultados obtidos pelo inventário de depressão de Beck, 48 por cento encontram-se em estado de depressão. CONCLUSÃO: Este estudo sugere que a categoria vivência de perdas deve ser utilizada como indicativo de fator psicológico predisponente às manifestações da doença arterial coronariana (DAC), apontando para a relação entre luto e depressão.

BACKGROUND: In literature, depression is associated with cardiovascular diseases. From clinical experience, we observed that the psychological category "experience of loss" was associated with the onset and development of coronary heart disease. The experience of loss caused by self-reported significant event(s) leads to grief and the psychosocial factors which predispose the patient to diseases. OBJECTIVE: To study the impact of the experience of loss by investigating the relationship between mourning and depression, in hospitalized patients with coronary heart disease. METHODS: 44 inpatients (50 percent men and 50 percent women, aged 33 to 65 years), with a diagnosis of acute myocardial infarction or angina, were evaluated. Two instruments were used: a semi-structured interview, for investigating the experience of loss and evaluating the state of grief; and the Beck Depression Inventory, for measuring the severity of depression. The results were expressed using the computer program Statistical Package for Social Sciences version 11.0. RESULTS: 66 percent of the patients were in mourning, the relationship between mourning and depression was significant (p<0,05), and we verified that 100 percent of the patients who had serious depression were in mourning. The most frequent self-reported significant event was death of a family member (47 percent) and death of a close person (13 percent), totaling 60 percent of the events, reported by 84 percent of the participants. According to the results of Beck Depression Inventory, 48 percent of them had depression. CONCLUSION: This study suggests that the psychological category "experience of loss" should be used as an indicator of the existence of psychological factors that could predispose the patient to CAD, and also confirms the relationship between a state of mourning and depression.

Depression: a predictor of smoking relapse in a 6-month follow-up after hospitalization for acute coronary syndrome.

OBJECTIVE: The objective of the study was to investigate whether depression is a predictor of postdischarge smoking relapse among patients hospitalized for myocardial infarction (MI) or unstable angina (UA), in a smoke-free hospital. METHODS: Current smokers with MI or UA were interviewed while hospitalized; patients classified with major depression (MD) or no humor disorder were reinterviewed 6 months post discharge to ascertain smoking status. Potential predictors of relapse (depression; stress; anxiety; heart disease risk perception; coffee and alcohol consumption; sociodemographic, clinical, and smoking habit characteristics) were compared between those with MD (n=268) and no humor disorder (n=135). RESULTS: Relapsers (40.4%) were more frequently and more severely depressed, had higher anxiety and lower self-efficacy scale scores, diagnosis of UA, shorter hospitalizations, started smoking younger, made fewer attempts to quit, had a consort less often, and were more frequently at the 'precontemplation' stage of change. Multivariate analysis showed relapse-positive predictors to be MD [odds ratio (OR): 2.549; 95% confidence interval (CI): 1.519-4.275] (P<0.001); 'precontemplation' stage of change (OR: 7.798; 95% CI: 2.442-24.898) (P<0.001); previous coronary bypass graft surgery (OR: 4.062; 95% CI: 1.356-12.169) (P=0.012); and previous anxiolytic use (OR: 2.365; 95% CI: 1.095-5.107) (P=0.028). Negative predictors were diagnosis of MI (OR: 0.575; 95% CI: 0.361-0.916) (P=0.019); duration of hospitalization (OR: 0.935; 95% CI: 0.898-0.973) (P=0.001); smoking onset age (OR: 0.952; 95% CI: 0.910-0.994) (P=0.028); number of attempts to quit smoking (OR: 0.808; 95% CI: 0.678-0.964) (P=0.018); and 'action' stage of change (OR: 0.065; 95% CI: 0.008-0.532) (P=0.010). CONCLUSION: Depression, no motivation, shorter hospitalization, and severity of illness contributed to postdischarge resumption of smoking by patients with acute coronary syndrome, who underwent hospital-initiated smoking cessation.

Estratégias de enfrentamento ("COPING") dos familiares de pacientes internados em Unidade de terapia Intensiva / Intensive care unit in patient's family coping

A Unidade de Terapia Intensiva (UTI) tem como objetivo prestar assistência permanente a pacientes em estado clínico grave. Apresenta características ambientais específicas, que expõem o paciente e seus familiares a sentimentos de angústia e ansiedade que permearão todas as relações. Acompanhar...

Smoking-associated factors in myocardial infarction and unstable angina: do gender differences exist?

The aim of this study was to investigate demographic and psychological characteristics associated with smoking in patients with acute coronary syndrome (myocardial infarction or unstable angina). Interviews were conducted with 348 consecutive hospitalized patients with acute coronary syndrome and included questions about demographic characteristics, coffee consumption, heart disease risk perception, economic status, alcohol consumption, depression, anxiety, and stress. Female group multivariate analysis showed that smoking in females was significantly and negatively associated with age, heart disease risk perception, and positively associated with coffee consumption. Male group multivariate analysis showed that for males, smoking was significantly and negatively associated with age, heart disease risk perception, and positively associated with coffee and alcohol consumption. Unlike studies conducted with non-heart disease patients, our results do not show an association between smoking and depression. Compared with nonsmokers, smokers with acute coronary syndrome are younger, more likely to drink coffee, and less likely to perceive smoking as a heart disease risk. Male smokers are also more likely to drink alcohol, indicating that they use more psycho-stimulants than do nonsmoking men and women who smoke.

Distanásia: vale a pena?

O desenvolvimento da tecnologia na área de saúde trouxe novas e importantes discussões relacionadas a forma de lidar com o paciente e com os processos de adoecer e morrer. A Bioética surgiu com o intuito de repensar estas questões, sendo atualmente a distanásia uma das mais importantes. Apesar de pouco discutida em nosso país, a distanásia começa a ocupar seu espaço. Pensar na possibilidade de interromper um tratamento médico, por não estar trazendo benefícios ao paciente, levanta diversas outras questões, já que pode até prolongar o sofrimento deste indivíduo. Objetiva-se então através deste trabalho refletir sobre a discussão da distanásia e suas possíveis conseqüências no Brasil, assim como um breve levantamento sobre os cuidados paliativos, que visam modificar este processo, oferecendo um outro tipo de cuidado ao paciente(AU)

The technological advances in the Health Area brought new and important discussions on how we deal with patients and with the processes of sickness and dying. The Bioethics comes with the purpose of reconsidering those questions. Nowadays the medical futility is one of the most important questions. Despite the lack of discussion on our country, the medical futility already has its space. Thinking on the possibility of stopping a medical treatment because it’s not bringing any benefits to the patient, raises a lot of different questions. It brings to the team its own finitude and limitation. The object of this work is to think over medical futility and it’s possible consequences in Brazil, as well as a short survey about palliative care, that comes to modify this process, offering a different kind of treatment(AU)

Valvopatias e suas implicações psicológicas / Aortic valve diseases and psychological implications

Caracterização do paciente e do momento do adoecer. O perfil mais freqüênte do paciente portador de uma valvopatia cardíaca é de um adulto jovem que, durante mais de uma década, apresentou-se assintomático. O surgimento dos desconfortos físicos ocorre com o agravamento do quadro, de tal forma que...

[Depression and Acute Coronary Syndromes: gender-related differences]. / Depressão e síndromes Isquêmicas Miocárdicas Instáveis: diferenças entre homens e mulheres.

OBJECTIVE: Investigate whether social and demographic characteristics, clinical diagnosis, smoking status, alcohol consumption, and anxiety are associated with depression in patients with Acute Coronary Syndromes (ACS) stratified by gender. METHODS: Three hundred forty-five consecutive patients with unstable myocardial ischemic syndrome (206 with myocardial infarction and 139 with unstable angina) were interviewed. The interviews included questions about sociodemographics, smoking status, screening for depression (Prime MD e BDI), trait and state anxiety, (IDATE), and alcohol consumption (AUDIT). RESULTS: Diagnosis of depression has significantly correlated with female gender, age under 50 years, and higher average scores on trait anxiety and state anxiety. Depressed men (245) were usually younger than 50 years of age, smokers and had higher average score on trait anxiety and state anxiety than those non-depressed. The multivariate analysis highlights that age is negatively associated with depression (OR 0.9519 95% CI 0.9261 - 0.9784) and that higher scores on trait anxiety are positively associated (OR 1.0691 95% CI 1.0375 - 1.1017) with depression in the male gender. In the female sample (100), depressed women differ from non-depressed women in that they have a higher average score on trait anxiety and state anxiety. In the multivariate analysis of the female sample, a higher score on trait anxiety was independently associated with depression (OR 1.1267 95% CI 1.0632 - 1.1940). CONCLUSION: It was concluded that, among hospitalized patients with ACS, women, as well as men under 50 years and who suffer from anxiety are more likely to experience depression.

Depressão e síndromes isquêmicas miocárdicas instáveis: diferencas entre homens e mulheres / Depression and acute coronary syndromes: gender-related differences

OBJETIVO: Investigar, em portadores de Síndromes Isquêmicas Miocárdicas Instáveis (SIMI) estratificados por sexo, se características sociodemográficas, diagnóstico clínico, tabagismo, consumo de álcool e ansiedade estão associados com depressão. MÉTODOS: Foram entrevistados 345 pacientes consecutivos com SIMI (206 com infarto agudo do miocárdio e 139 com angina instável). As entrevistas incluíram questões sobre características sociodemográficas, tabagismo, avaliacão de depressão (Prime MD e BDI), de ansiedade traco e ansiedade estado (IDATE), e de consumo de álcool (AUDIT). RESULTADOS: O diagnóstico de depressão se correlacionou, significativamente, com sexo feminino, idade inferior a 50 anos e escores médios mais elevados de ansiedade traco e ansiedade estado. Os homens (245) com depressão eram freqüentemente mais jovens que 50 anos, fumantes, e apresentavam escore médio de ansiedade traco e ansiedade estado mais elevado que os não deprimidos. A análise multivariada aponta que, no sexo masculino, idade está negativamente associada (OR 0,9519, 95 por cento IC 0,9261 - 0,9784) e escores mais altos de ansiedade traco estão positivamente associados (OR 1,0691 95 por cento IC 1,0375 - 1,1017) com depressão. Na amostra feminina (100), mulheres com depressão diferenciam-se das sem depressão por apresentarem escore médio mais alto de ansiedade traco e de ansiedade estado. Na análise multivariada da amostra feminina, escore mais alto de ansiedade traco associou-se de forma independente à depressão (OR 1,1267 95 por cento IC 1,0632-1,1940). CONCLUSAO: Conclui-se que, em pacientes hospitalizados com SIMI, as mulheres, os homens com menos de 50 anos e os ansiosos têm mais chance de apresentarem depressão.

Tratamento não-farmacológico da síndrome metabólica: visão do psicólogo e do nutricionista / Non-pharmacological treatment of the metabolic syndrome: psychologist and nutritionist vision

Os hábitos de vida são multifatorialmente determinados, coexistindo aspectos nutricionais, psicológicos, sociais e relativos à atividade física, o que requer a necessidade de uma intervenção complexa para modificá-Ios. A intervenção não-farmacológica na síndrome metabólica está baseada, fundamentalmente, em programas interdisciplinares que visem a mudança de estilo de vida, contribuindo assim para a redução da incidência de complicações decorrentes da síndrome. O objetivo desse artigo é caracterizar fatores emocionais associados à etiologia da síndrome metabólica e caracterizar a instrumentalização do paciente sobre re-educação alimentar, com enfoque na identificação dos fatores dificultadores da efetiva mudança de estilo de vida. Para tanto, a estratégia de intervenção utilizada é interdisciplinar. Os resultados parciais dessa intervenção também estão descritos nesse artigo. Nessa abordagem verificou-se perda ponderal, com redução do índice de massa corpórea e da circunferência abdominal; melhora da percepção de risco da doença como um todo, redução da resistência a mudanças e conscientização quanto à associação entre o excesso alimentar e a condição psíquica, favorecendo a adoção de novos hábitos de vida

Depressão e síndromes isquêmicas miocárdicas instáveis: diferenças entre homens e mulheres

Objetivo: Investigar, em portadores de Síndromes Isquêmicas Miocárdicas Instáveis (SIMI) estratificados por gênero, se características sócio-demográficas, diagnóstico clínico, tabagismo, consumo de álcool e ansiedade estão associados com depressão. Métodos: Foram entrevistados 345 pacientes hospitalizados consecutivos, com SIMI. As entrevistas incluíram questões sobre características sócio-demográficas, tabagismo, avaliação de depressão (Prime MD e BDI), de ansiedade- traço e ansiedade- estado (IDATE), e de consumo de álcool (AUDIT). Resultados: Depressão se correlacionou significativamente com gênero feminino, idade inferior a 50 anos, e escores médios mais elevados de ansiedade- traço e ansiedade- estado. Os homens (245) com depressão eram frequentemente mais jovens que 50 anos, fumantes, e apresentavam escore médio de ansiedade- traço e ansiedade- estado mais elevados do que os não deprimidos. A análise multivariada aponta que, no gênero masculino, idade está negativamente associada (OR 0,9519, 95% IC 0,9261-0,9784) e escores mais altos de ansiedade-traço estão positivamente associados (OR 1,0691 95% IC 1,0375- 1,1017) com depressão. Na amostra feminina (100), mulheres com depressão diferenciam-se das sem depressão por apresentarem escore médio mais alto de ansiedade-traço e de ansiedade-estado. Na análise multivariada da amostra feminina, escore mais alto de ansiedade-traço associou-se de forma independente à depressão (OR 1,1267 95% IC 1,0632-1,1940). Conclusão Conclui-se que, em pacientes com SIMI hospitalizados, as mulheres, os homens com menos de 50 anos e os ansiosos têm mais chance de apresentarem depressão.(AU)

Objective: To investigate patients with acute coronary syndromes (ACS) stratified by gender, if sociodemographic characteristics, clinical diagnostic, smoking, alcohol consumption and anxiety are associated with depression. Methods: Interviews were conducted with 348 consecutive in-patients with myocardial infarction (206) or unstable angina (139). Interviews included questions about demographic characteristics, smoking, depression (Prime-MD, BDI), state of anxiety, trait anxiety (STAI) and alcohol consumption (AUDIT). Results: In the global population, the presence of major depression correlated significantly with the female gender, below 50 years of age, and with higher trait anxiety and state anxiety scores. Depressed males (245) were more frequently younger than 50 years of age, were typically smokers, and showed scores of trait anxiety and state anxiety higher than the non depressed. Multivariate analysis showed that for males, depression was negatively associated with age (OR 0.9519, 95% IC 0.9261-0,9784) and positively associated with higher trait anxiety scores (OR 1.0691 95% IC 1.0375- 1.1017). Considering the female sample (100), the following was found: depressed women, relative to the non-depressed, showed higher trait and state anxiety scores. The multivariate analysis of the female sample showed that higher trait anxiety scores were independently associated with depression (OR 1.1267 95% IC 1.0632-1.1940). Conclusion: In ACS hospitalized patients, female gender, men younger than 50 years of age and those prone to anxiety, are more likely to present symptoms of depression.(AU)

Depressão na infância e adolescência: revisão bibliográfica / Depression in childhood and adolescence: a review

O conceito depressão vem sendo estudado por vários autores e com o decorrer do tempo foi sendo classificado de diversas formas. Contudo, essa doença é pouco conhecida quando se trata de crianças e adolescentes. Seus sintomas não são percebidos com facilidade pelos pais e/ou familiares. Dependendo da fase de desenvolvimento da criança e do adolescente, a depressão pode se expressar forma variada. Os bebês podem apresentar, entre os vários sintomas, expressão facial triste e alterações do apetite e do sono; os pré-escolares podem ter disforia, apatia e isolamento social; os escolares, queixas somáticas e humor depressivo, sentimento de inferioridade e de inutilidade, e queda do desempenho escolar, entre as várias manifestações da doença. A depressão é uma doença grave e pode levar a isolamento, baixo resndimento escolar, uso de drogas como tentativa de se sentir melhor e baixa auto-estima ou lentificação. Por estar em desenvolvimento, a criança e/ou o adolescentenão têm capacidade para compreender o que lhes acontece internamente...

The Wada Test: contributions to standardization of the stimulus for language and memory assessment

O Teste de Wada (TW) é parte integrante da avaliação pré-cirúrgica para epilepsias de difícil controle. O TW não é padronizado e os protocolos diferem em vários aspectos, incluindo tipos de estímulos para avaliação de memória, tempo de apresentação e metodologia de avaliação. O objetivo deste estudo foi contribuir no estabelecimento de parâmetros para utilização TW para a população brasileira, investigando o desempenho de 100 controles normais, sem medicação. Dois modelos (Modelos A e B) foram utilizados, baseados no Procedimento de Montreal e adaptadas do protocolo de Gail Risse (MEG-MN,EUA). Foram observadas as proporções de acerto dos sujeitos normais para os modelos de TW, em seguida, os dois modelos foram comparados entre si. Os resultados demonstraram que os dois modelos são similares mas, observaram-se significativas diferenças entre os tipos de estímulos. Os resultados sugerem que tipos de estímulos podem influenciar os resultados do TW e esses dados devem ser considerados na construção de modelos e comparações entre diferentes protocolos.

The Wada Test: contributions to standardization of the stimulus for language and memory assessment.

The Wada Test (WT) is part of the presurgical evaluation for refractory epilepsy. The WT is not standardized and the protocols differ in important ways, including stimulus type of material presented for memory testing, timing of presentations and methods of assessment. The aim of this study was to contribute to establish parameters for a WT to Brazilian population investigating the performance of 100 normal subjects, without medication. Two parallel models were used based on Montreal Procedure adapted from Gail Risse's (MEG-MN,EUA) protocol. The proportions of correct responses of normal subjects submitted to two parallel WT models were investigated and the two models were compared. The results showed that the two models are similar but significant differences among the stimulus type were observed. The results suggest that the stimulus type may influence the results of the WT and should be considered when constructing models and comparing different protocols.