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1.
Sci Rep ; 9(1): 6043, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30988325

RESUMO

The aim of this study was to measure intra- and interobserver agreement among radiologists in the assessment of pancreatic perfusion by computed tomography (CT). Thirty-nine perfusion CT scans were analyzed. The following parameters were measured by three readers: blood flow (BF), blood volume (BV), mean transit time (MTT) and time to peak (TTP). Statistical analysis was performed using the Bland-Altman method, linear mixed model analysis, and intraclass correlation coefficient (ICC). There was no significant intraobserver variability for the readers regarding BF, BV or TTP. There were session effects for BF in the pancreatic body and MTT in the pancreatic tail and whole pancreas. There were reader effects for BV in the pancreatic head, pancreatic body and whole pancreas. There were no effects for the interaction between session and reader for any perfusion parameter. ICCs showed substantial agreement for the interobserver measurements and moderate to substantial agreement for the intraobserver measurements, with the exception of MTT. In conclusion, satisfactory reproducibility of measurements was observed for TTP in all pancreatic regions, for BF in the head and BV in the tail, and these parameters seem to ensure a reasonable estimation of pancreatic perfusion.

2.
Int J Gynaecol Obstet ; 143(1): 59-65, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29978470

RESUMO

OBJECTIVE: To evaluate pregnancy outcomes among women with pre-gestational diabetes. METHODS: Retrospective analysis of pregnant women with type 1 or type 2 diabetes attending a university hospital in Brazil. Maternal characteristics and pregnancy outcomes were compared among deliveries between May 1, 2005, and December 31, 2010, and between January 1, 2011, and December 31, 2015. Risks were calculated by Poisson regression. RESULTS: In total 220 women were included. Type 1 diabetes was more frequent in 2005-2010 than in 2011-2015, and type 2 diabetes was more frequent in 2011-2015 (P=0.005). History of macrosomia (P=0.011), hypertensive disorders of pregnancy (P=0.015), and pre-gestational excess weight (body mass index >25 kg/m2 ; P=0.003) was more frequent in 2011-2015. For women with type 1 diabetes, pre-gestational weight (P=0.007) and glycated hemoglobin (P=0.026) were higher in 2011-2015. For women with type 2 diabetes, previous hypertensive disorders of pregnancy (P=0.032) were more prevalent and family history of diabetes (P<0.001) less prevalent in 2011-2015. Adverse pregnancy outcomes were similar for type 1 and type 2, and across both periods. CONCLUSION: Type 2 diabetes became more common over the two time periods and women with type 1 diabetes had higher pre-gestational weight. Perinatal outcomes were similar.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Adulto , Índice de Massa Corporal , Brasil , Feminino , Macrossomia Fetal/epidemiologia , Hemoglobina A Glicada , Humanos , Gravidez , Gravidez em Diabéticas , Estudos Retrospectivos , Ganho de Peso , Adulto Jovem
4.
Arch Endocrinol Metab ; 62(1): 55-63, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29694632

RESUMO

Objective Our objective was to evaluate gestational weight gain (GWG) patterns and their relation to birth weight. Subjects and methods We prospectively enrolled 474 women with gestational diabetes mellitus (GDM) at a university hospital (Porto Alegre, Brazil, November 2009-May 2015). GWG was categorized according to the 2009 Institute of Medicine guidelines; birth weight was classified as large (LGA) or small (SGA) for gestational age. Adjusted relative risks (aRRs) and 95% confidence intervals (95% CIs) were determined. Results Adequate GWG occurred in 121 women [25.5%, 95% CI: 22, 30%]; excessive, in 180 [38.0%, 95% CI: 34, 43%]; and insufficient, in 173 [36.5%, 95% CI: 32, 41%]. In women with normal body mass index (BMI), the prevalence of SGA was higher in those with insufficient compared to adequate GWG (30% vs. 0%, p < 0.001). In women with BMI ≥ 25 kg/m2, excessive GWG increased the prevalence of LGA [aRR 2.58, 95% CI: 1.06, 6.29] and protected from SGA [aRR 0.25, 95% CI: 0.10, 0.64]. Insufficient vs. adequate GWG did not influence the prevalence of SGA [aRR 0.61, 95% CI: 0.31, 1.22]; insufficient vs. excessive GWG protected from LGA [aRR 0.46, 95% CI: 0.23, 0.91]. Conclusions One quarter of this cohort achieved adequate GWG, indicating that specific ranges have to be tailored for GDM. To prevent inadequate birth weight, excessive GWG in women with higher BMI and less than recommended GWG in normal BMI women should be avoided; less than recommended GWG may be suitable for overweight and obese women.


Assuntos
Peso ao Nascer/fisiologia , Diabetes Gestacional/fisiopatologia , Ganho de Peso/fisiologia , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Prospectivos , Fatores Socioeconômicos
5.
Arch. endocrinol. metab. (Online) ; 62(1): 55-63, Jan.-Feb. 2018. tab
Artigo em Inglês | LILACS-Express | ID: biblio-887628

RESUMO

ABSTRACT Objective Our objective was to evaluate gestational weight gain (GWG) patterns and their relation to birth weight. Subjects and methods We prospectively enrolled 474 women with gestational diabetes mellitus (GDM) at a university hospital (Porto Alegre, Brazil, November 2009-May 2015). GWG was categorized according to the 2009 Institute of Medicine guidelines; birth weight was classified as large (LGA) or small (SGA) for gestational age. Adjusted relative risks (aRRs) and 95% confidence intervals (95% CIs) were determined. Results Adequate GWG occurred in 121 women [25.5%, 95% CI: 22, 30%]; excessive, in 180 [38.0%, 95% CI: 34, 43%]; and insufficient, in 173 [36.5%, 95% CI: 32, 41%]. In women with normal body mass index (BMI), the prevalence of SGA was higher in those with insufficient compared to adequate GWG (30% vs. 0%, p < 0.001). In women with BMI ≥ 25 kg/m2, excessive GWG increased the prevalence of LGA [aRR 2.58, 95% CI: 1.06, 6.29] and protected from SGA [aRR 0.25, 95% CI: 0.10, 0.64]. Insufficient vs. adequate GWG did not influence the prevalence of SGA [aRR 0.61, 95% CI: 0.31, 1.22]; insufficient vs. excessive GWG protected from LGA [aRR 0.46, 95% CI: 0.23, 0.91]. Conclusions One quarter of this cohort achieved adequate GWG, indicating that specific ranges have to be tailored for GDM. To prevent inadequate birth weight, excessive GWG in women with higher BMI and less than recommended GWG in normal BMI women should be avoided; less than recommended GWG may be suitable for overweight and obese women.

6.
J Pediatr Gastroenterol Nutr ; 66(3): 442-446, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29176477

RESUMO

OBJECTIVE: Esophageal variceal bleeding is a severe complication of portal hypertension. The standard diagnostic screening test and therapeutic procedure for esophageal varices (EV) is endoscopy, which is invasive in pediatric patients. This study aimed to evaluate the role of noninvasive parameters as predictors of large varices in children with intrahepatic portal hypertension. METHODS: Participants included in this cross-sectional study underwent a screening endoscopy. Variceal size, red marks, and portal gastropathy were assessed and rated. Patients were classified into two groups: Group 1 (G1) with small or no varices and Group 2 (G2) with large varices. The population consisted of 98 children with no history of gastrointestinal (GI) bleeding, with a mean age of 8.9 ±â€Š4.7 years. The main outcome evaluated was the presence of large varices. RESULTS: The first endoscopy session revealed the presence of large varices in 32 children. The best noninvasive predictors for large varices were platelets (Area under the ROC Curve [AUROC] 0.67; 95% CI 0.57-0.78), the Clinical Prediction Rule (CPR; AUROC 0.65; 95% CI 0.54-0.76), and risk score (AUROC 0.66; 95% CI 0.56-0.76). The logistic regression model showed that children with a CPR value under 114 were 8.59 times more likely to have large varices. Risk scores higher than -1.2 also increased the likelihood of large varices (OR 6.09; P = 0.014), as did a platelet count/spleen size z score lower than 25 (OR 3.99; P = 0.043). The combination of these three tests showed a high negative predictive value. CONCLUSIONS: The CPR, the risk score, and the platelet count/spleen size z score could be helpful in identifying cirrhotic children who may be eligible for endoscopy.


Assuntos
Varizes Esofágicas e Gástricas/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Adolescente , Biomarcadores/sangue , Criança , Pré-Escolar , Estudos Transversais , Técnicas de Apoio para a Decisão , Endoscopia Gastrointestinal , Varizes Esofágicas e Gástricas/sangue , Varizes Esofágicas e Gástricas/etiologia , Feminino , Hemorragia Gastrointestinal/sangue , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/complicações , Lactente , Modelos Logísticos , Masculino , Contagem de Plaquetas , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Baço/patologia
7.
Nutr Clin Pract ; 33(6): 887-892, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28727923

RESUMO

BACKGROUND: Ulna length (UL) has been used in mathematical formulas to predict the body height of healthy and sick individuals. However, the evaluation of its use with patients admitted to intensive care units (ICU) is scarce. The objective of this study was to develop a mathematical equation to estimate critically ill patients' height using the UL measure and to evaluate its agreement with measured standing height. METHODS: This cross-sectional study was performed at the ICU of a tertiary hospital in Brazil. A total of 100 patients aged ≥18 years who had their body height measured before ICU admission were enrolled. The equation was developed through multiple linear regression, and its agreement was assessed through paired Student's t test and Bland-Altman plot. RESULTS: The following formula was obtained: height in cm = 153.492 - (7.97 × sex [sex: male = 1, female = 2]) + (0.974 × UL [in cm]). The difference between means of measured height (MH) and height estimated from UL was not significant (166.26 ± 8.75 cm and 166.30 ± 5.29 cm, respectively, P = .96), and a significant correlation (r = 0.624, P < .001) was detected. In the Bland-Altman analysis, UL was in agreement with MH; however, there was a significant bias (P < .001) suggesting that it may be disproportional and dependent on the average's height value. CONCLUSION: The mathematical equation for height estimation using UL developed in this study matched the MH of critically ill patients. However, we suggest more studies for its validation.


Assuntos
Antropometria/métodos , Estatura , Estado Terminal , Unidades de Terapia Intensiva , Perna (Membro) , Conceitos Matemáticos , Ulna , Adulto , Idoso , Pesos e Medidas Corporais , Brasil , Cuidados Críticos , Estudos Transversais , Feminino , Hospitalização , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Fatores Sexuais , Centros de Atenção Terciária
8.
J. pediatr. (Rio J.) ; 93(3): 253-259, May.-June 2017. graf
Artigo em Inglês | LILACS-Express | ID: biblio-841357

RESUMO

Abstract Objective: This study describes a quantitative and qualitative methodology to assess hedonic responses to sweet stimulus in healthy newborns. Methods: A descriptive, cross-sectional, observational study, with healthy newborns (up to 24 h of life), between 37 and 42 gestational weeks, vaginally born and breastfed previously to all tests. The evaluation of the newborns reactions was performed by hedonic facial expression analysis, characterized by facial expressions with rhythmic serial tongue protrusion after neutral or sweet solution intake. Initially, 1 mL of water solution was provided to the newborn, followed by a 1-minute recording. Afterwards, the same amount of 25% sucrose solution was provided, performing a second recording. The concordance between researchers was analyzed by the Bland-Altman statistical method. Results: A total of 100 newborns (n = 49 males, n = 51 females; mean lifetime = 15 h 12 min ± 6 h 29 min) were recorded for neutral and sucrose solution intake, totaling 197 videos (n = 3 missing in the water treatment). These videos were double-blind analyzed and the test revealed a 90% concordance between the two trained researchers, in relation to both solutions. The intraclass correlation coefficient was 0.99 for both solutions, with a significant increase in frequency of hedonic expressions evoked by sucrose solution intake. Conclusions: These results confirm that the proposed method has an efficient power to detect significant differences between neutral and sucrose stimuli. In conclusion, this evaluation method of hedonic facial reactions in newborns reflects the response to a specific taste.


Resumo Objetivo: Descrever quantitativamente e qualitativamente uma metodologia para avaliar as respostas faciais hedônicas, em recém-nascidos saudáveis, ao estímulo doce. Métodos: Trata-se de um estudo descritivo, transversal e observacional, com recém-nascidos saudáveis (com até 24 horas de vida), entre 37-42 semanas gestacionais, nascidos por parto vaginal e alimentados previamente aos testes. A avaliação das reações hedônicas dos recémnascidos foi considerada pelas expressões faciais com séries rítmicas de protrusões de língua após a ingestão de solução neutra ou doce. Inicialmente, 1 mL de solução neutra (água) foi fornecida para o recém-nascido, seguido de uma filmagem de 1 minuto. Sequencialmente, a mesma quantidade de solução de sacarose 25% foi fornecida, realizando-se uma segunda gravação. A concordância entre os pesquisadores foi analisada pelo método estatístico de Bland-Altman. Resultados: Um total de 100 recém-nascidos (n = 49 do sexo masculino, n = 51 do sexo feminino, tempo de vida média = 15 h 12 min ± 6 h 29 min) foram registrados para a ingestão de solução neutra e de sacarose, totalizando 197 vídeos (n = 3 perdas para o tratamento água). Estes vídeos foram analisados em duplo-cego e o teste revelou uma concordância de 90%, para ambas as soluções, entre os pesquisadores treinados. O coeficiente de correlação intraclasse foi de 0,99 para as duas substâncias, com um aumento significativo nas frequências das expressões faciais hedônicas evocadas pela ingestão de sacarose. Conclusões: Estes resultados confirmam que o método proposto possui poder estatístico eficiente para detectar diferenças entre estímulos neutros e sacarose. Em conclusão, este método de avaliação de reações faciais hedônicas em recém-nascidos reflete a resposta para um gosto específico.

9.
J Pediatr (Rio J) ; 93(3): 253-259, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27886807

RESUMO

OBJECTIVE: This study describes a quantitative and qualitative methodology to assess hedonic responses to sweet stimulus in healthy newborns. METHODS: A descriptive, cross-sectional, observational study, with healthy newborns (up to 24h of life), between 37 and 42 gestational weeks, vaginally born and breastfed previously to all tests. The evaluation of the newborns reactions was performed by hedonic facial expression analysis, characterized by facial expressions with rhythmic serial tongue protrusion after neutral or sweet solution intake. Initially, 1mL of water solution was provided to the newborn, followed by a 1-minute recording. Afterwards, the same amount of 25% sucrose solution was provided, performing a second recording. The concordance between researchers was analyzed by the Bland-Altman statistical method. RESULTS: A total of 100 newborns (n=49 males, n=51 females; mean lifetime=15h 12min±6h 29min) were recorded for neutral and sucrose solution intake, totaling 197 videos (n=3 missing in the water treatment). These videos were double-blind analyzed and the test revealed a 90% concordance between the two trained researchers, in relation to both solutions. The intraclass correlation coefficient was 0.99 for both solutions, with a significant increase in frequency of hedonic expressions evoked by sucrose solution intake. CONCLUSIONS: These results confirm that the proposed method has an efficient power to detect significant differences between neutral and sucrose stimuli. In conclusion, this evaluation method of hedonic facial reactions in newborns reflects the response to a specific taste.


Assuntos
Expressão Facial , Comportamento do Lactente/fisiologia , Recém-Nascido/crescimento & desenvolvimento , Sacarose/administração & dosagem , Edulcorantes/administração & dosagem , Estudos Transversais , Água Potável , Feminino , Humanos , Masculino
10.
BMC Health Serv Res ; 15: 455, 2015 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-26438377

RESUMO

BACKGROUND: Within the Brazilian Unified Health System (SUS), Referral Centers (RCs) are care facilities that provide specialized services. The objective of this study was to evaluate the efficacy of care provided to patients with multiple myeloma (MM) at a specialized RC (Hospital de Clínicas de Porto Alegre Referral Center for Multiple Myeloma, CRMM-HCPA) and to compare quality of life between patients with MM treated at CRMM-HCPA and those treated at non-RC facilities. METHODS: A 6-month cohort study was conducted in patients with MM receiving thalidomide from the Rio Grande do Sul State Health Department and treated at CRMM-HCPA and patients receiving treatment at other, non-RC care facilities. Thirty-two patients were included in the study, 19 from CRMM-HCPA and 13 from other institutions. To analyze the efficacy of care provided at CRMM-HCPA, the main outcome measure was the time from diagnosis to referral for autologous hematopoietic stem cell transplantation (HSCT). This outcome measure was assessed using questionnaires specifically designed for this study. Quality of life was also assessed, using the SF-36 questionnaire. RESULTS: Time from MM diagnosis to referral for autologous HSCT in each group was measured only in patients aged ≤ 65 years (n = 25); of these, 15 were recruited from CRMM-HCPA and 10 from other institutions. In this analysis, there was a significant difference (p = 0.036) in time elapsed between diagnosis and referral for autologous HSCT, which was significantly shorter for patients treated at CRMM-HCPA (median, 9 months; IQR, 8.5-14.5) than for those treated elsewhere (median, 24 months; IQR, 16-24). On quality of life analysis, there was a significant difference in the Social Functioning domain of the SF-36 questionnaire, which relates to performance of social activities (p = 0.02). CONCLUSIONS: The Referral Center model provided seems to be a more efficient treatment strategy as compared with other health care facilities, as it enabled a reduction in time to transplantation. Patients treated at CRMM-HCPA demonstrated greater ease in performing social activities, with less interference from physical or emotional problems.


Assuntos
Mieloma Múltiplo , Assistência Centrada no Paciente , Centros de Cuidados de Saúde Secundários , Adulto , Idoso , Brasil , Estudos de Coortes , Feminino , Transplante de Células-Tronco Hematopoéticas , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/cirurgia , Qualidade de Vida , Inquéritos e Questionários
11.
Transplantation ; 98(11): 1199-204, 2014 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-25222011

RESUMO

BACKGROUND: Return to work is an objective parameter used worldwide to evaluate the success of organ transplantation and is especially feasible after renal transplantation. This study sought to describe the frequency of return to work after renal transplantation and related characteristics. METHODS: Retrospective cohort of 511 isolated kidney transplant recipients was recruited from a Brazilian referral center from January 2005 to December 2009; all were matched to the public social security database to determine inclusion and benefit awards, as well as the rate of resumption of contributions to the public social security system, a surrogate marker of work rehabilitation. Characteristics associated with work return were analyzed. RESULTS: No social security records were found for 28 subjects. The remaining 483 subjects had a mean age of 45±13 years; 62% were male; 401 (83%) received some public social security benefit; 298 were paying dues and could, therefore, receive temporary or permanent disability benefits. Of these, 78 subjects made social security payments after transplantation, resulting in a work return rate of 26% (95% confidence interval, 21-32). Younger age, living donor graft, and chronic glomerulonephritis were significantly associated with return to work. CONCLUSION: In Brazil, most renal transplant recipients are on social security benefits, but only a small proportion return to work after surgery. Clinical characteristics may help define work resumption trends.


Assuntos
Transplante de Rim/métodos , Insuficiência Renal/cirurgia , Retorno ao Trabalho , Adolescente , Adulto , Fatores Etários , Idoso , Brasil , Emprego , Feminino , Glomerulonefrite/complicações , Humanos , Transplante de Rim/economia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/economia , Estudos Retrospectivos , Previdência Social , Adulto Jovem
12.
Clin Nucl Med ; 37(8): 748-54, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22785501

RESUMO

BACKGROUND: The prognostic significance of the difference between poststress and at rest left ventricular ejection fraction (ΔLVEF) in patients sent for diagnostic myocardial perfusion study (MPS) is not well characterized. The purpose of this study was to prospectively evaluate the ability of ΔLVEF in further risk stratifying these patients in addition to the severity/extent of myocardial perfusion abnormalities expressed as the total perfusion deficit at stress (sTPD), according to the type of stress used. METHODS AND RESULTS: Two-day 99mTc-MIBI MPS after stress and rest were obtained for 507 patients subdivided according to the type of stress used, sTPD values, and ΔLVEF. Subsequent cardiac events were determined through a standardized questionnaire applied 1, 2, and 6 years after MPS. Independent of the type of stress used, the 6-year event rate with progressive perfusion and functional abnormalities combined was significant for total events, all-cause death, cardiac death, and revascularization but not for myocardial infarct. When ΔLVEF decreased by more than -10%, only those individuals with sTPD of 5% or less had increased 6-year total event rates [5.9% vs 15% for those submitted to treadmill test (P < 0.001) and 8.3% vs 19% when submitted to pharmacological stress (P = 0.001)]. An sTPD greater than 5% was the only variable predictive of total events when multivariate analysis was applied (P < 0.001 for treadmill exercise and P = 0.033 for dipyridamole). CONCLUSIONS: Estimation of ΔLVEF in addition to sTPD seems to improve risk stratification for future events when ΔLVEF decreases by more than -10% for those individuals with normal or near-normal myocardial perfusion (sTPD ≤ 5%). An sTPD greater than 5% was a better prognostic indicator of future events when compared with ΔLVEF for individuals with greater perfusion abnormality at stress.


Assuntos
Teste de Esforço , Imagem do Acúmulo Cardíaco de Comporta/métodos , Imagem de Perfusão do Miocárdio/métodos , Descanso/fisiologia , Volume Sistólico/fisiologia , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Demografia , Dipiridamol/administração & dosagem , Dipiridamol/farmacologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
13.
Rev. bras. psiquiatr ; 33(1): 23-29, Mar. 2011. ilus, tab
Artigo em Inglês | LILACS | ID: lil-584094

RESUMO

OBJECTIVE: To investigate predictors of relapse two years after a brief cognitive-behavior group therapy in patients with panic disorder who had failed to respond to pharmacologic treatment. METHOD: A total of 56 patients with panic disorder were followed who had met remission criteria at 1 year evaluation after 12 sessions of cognitive-behavior group therapy. Demographic and clinical features and life stressors were investigated as predictors of relapse. RESULTS: At the 2 year assessment, 39 (70 percent) patients maintained remission status and use of medication was reduced significantly, such that 36 (64 percent) patients were not undergoing any psychiatric treatment. Among all independent variables investigated, only "conflict" as a stressful life event, RR = 3.20 (CI95 percent 1.60; 7.20 - p = 0.001), and the severity or residual anxiety symptoms, RR = 3.60 for each scale point (CI95 percent 1.02; 1.08 - p < 0.001), emerged as nonredundant predictors. CONCLUSION: In spite of the high treatment gains across two years of follow-up, clinicians should pay attention to stress management and to the role of residual symptoms during this period. Results were discussed in the context of treatment cost-efficacy and potential strategies to prolong treatment gains from cognitive-behavior group therapy.


OBJETIVO: Investigar os preditores de recaída após dois anos de terapia cognitivo-comportamental em grupo breve para pacientes com transtorno do pânico que não responderam ao tratamento farmacológico. MÉTODO: Um total de 56 pacientes com transtorno do pânico que preencheram os critérios de remissão em um ano de avaliação após as 12 sessões da terapia cognitivo-comportamental em grupo foram acompanhados. As características demográficas, clínicas e os estressores de vida foram investigados como preditores de recaída. RESULTADOS: No segundo ano de avaliação, 39 (70 por cento) pacientes mantiveram-se em remissão e o uso de medicação reduziu significativamente, de tal forma que 36 (64 por cento) pacientes não estavam em tratamento psiquiátrico. Entre todas as variáveis independentes investigadas, somente o "conflito" como evento estressor de vida, RR = 3,20 (CI95 por cento 1,60; 7,20 - p = 0,001) e a gravidade ou os sintomas residuais de ansiedade, RR = 3,60 para cada ponto a mais da escala (CI95 por cento 1,02; 1,08 - p < 0,001), foram preditores de recaída. CONCLUSÃO: A despeito dos ganhos do tratamento através dos dois anos, os terapeutas devem manter-se atentos em relação ao manejo do estresse e no papel dos sintomas residuais de ansiedade durante este período. Os resultados são discutidos no contexto de custo-eficácia do tratamento e nas potenciais estratégias para prolongar os ganhos da terapia cognitivo-comportamental em grupo.


Assuntos
Adulto , Feminino , Humanos , Masculino , Terapia Cognitivo-Comportamental , Transtorno de Pânico/terapia , Seguimentos , Transtorno de Pânico/psicologia , Recidiva , Fatores de Tempo
14.
Braz J Psychiatry ; 33(1): 23-9, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20414587

RESUMO

OBJECTIVE: To investigate predictors of relapse two years after a brief cognitive-behavior group therapy in patients with panic disorder who had failed to respond to pharmacologic treatment. METHOD: A total of 56 patients with panic disorder were followed who had met remission criteria at 1 year evaluation after 12 sessions of cognitive-behavior group therapy. Demographic and clinical features and life stressors were investigated as predictors of relapse. RESULTS: At the 2 year assessment, 39 (70%) patients maintained remission status and use of medication was reduced significantly, such that 36 (64%) patients were not undergoing any psychiatric treatment. Among all independent variables investigated, only "conflict" as a stressful life event, RR = 3.20 (CI95% 1.60; 7.20 - p = 0.001), and the severity or residual anxiety symptoms, RR = 3.60 for each scale point (CI95% 1.02; 1.08 - p < 0.001), emerged as nonredundant predictors. CONCLUSION: In spite of the high treatment gains across two years of follow-up, clinicians should pay attention to stress management and to the role of residual symptoms during this period. Results were discussed in the context of treatment cost-efficacy and potential strategies to prolong treatment gains from cognitive-behavior group therapy.


Assuntos
Terapia Cognitivo-Comportamental , Transtorno de Pânico/terapia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Transtorno de Pânico/psicologia , Recidiva , Fatores de Tempo
15.
Oncol Nurs Forum ; 36(3): E153-8, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19403443

RESUMO

PURPOSE/OBJECTIVES: To assess differences in ways women with breast cancer evaluate their own quality of life (QOL) compared to perceptions of their partners and to identify factors that influence dissimilarities in QOL perceptions. DESIGN: Cross-sectional study. SETTING: Breast unit in southern Brazil. SAMPLE: 73 women with stage I-III breast cancer and their partners. Most participants were middle-aged, with partners of long-term cohabitation. METHODS: QOL was evaluated with the World Health Organization Quality of Life-Brief Form (WHOQOL-BREF), Beck Depression Inventory, and WHOQOL-BREF adapted for a third person. MAIN RESEARCH VARIABLES: Demographic and clinical features, QOL, partners' perceptions, and depression. FINDINGS: No differences were found between the perceptions of QOL in different domains between the patients and their partners. Depression in women seemed to be the only variable that interfered in a consistent manner with the congruity of the QOL assessments made by patients and their partners. CONCLUSIONS: Partners of women with breast cancer may be viewed as reliable surrogates to assess patients' QOL. IMPLICATIONS FOR NURSING: Partners' judgments of patients' QOL may be important in some circumstances, particularly when patients are not able to answer questions about their own QOL because of cognitive or functional limitations. Nurses must be aware that partners are the most frequent informal caregivers and should be included in the entire treatment process.


Assuntos
Neoplasias da Mama/enfermagem , Neoplasias da Mama/psicologia , Depressão/psicologia , Qualidade de Vida , Cônjuges/psicologia , Depressão/enfermagem , Saúde da Família , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Enfermagem Oncológica , Sobreviventes/psicologia
16.
J Affect Disord ; 112(1-3): 279-83, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18539339

RESUMO

INTRODUCTION: Sleep deprivation (SD) has been used as an alternative approach to treat major depressive disorder (MDD). Caffeine, due to its stimulating effect, could be an alternative to promote sleep deprivation. However, there are no data about its potential influence on the antidepressive effect of SD. The objective of this study is to assess the effect of caffeine on SD in non-psychotic patients with moderate to severe unipolar depression. METHODS: Randomized, double-blind, crossover clinical trial comparing caffeine and placebo in moderate to severe depressed patients who underwent total sleep deprivation (SD). The patients were assessed with items of the Bond-Lader scale, the 6-item Hamilton Depression Rating Scale (HAMD-6), and the Clinical Global Impression (CGI)-Severity/Improvement. RESULTS: Twenty patients participated in this study. The patients who consumed caffeine presented the same level of energy before and after sleep deprivation (lethargic-energetic item of the Bond-Lader scale), while the patients in the placebo group had a reduced level of energy after sleep deprivation (p=0.0045). There was no difference between the caffeine and placebo groups in the other items of the Bond-Lader scale. CONCLUSION: The combined use of caffeine and SD can be a useful strategy to keep the patient awake without impairing the effect of SD on depressed outpatients. However, further studies involving patients who have responded to SD are needed in order to verify if caffeine also does not interfere with the results in this group.


Assuntos
Cafeína/uso terapêutico , Transtorno Depressivo/terapia , Privação do Sono , Adulto , Assistência Ambulatorial , Cafeína/farmacologia , Ritmo Circadiano/efeitos dos fármacos , Terapias Complementares/métodos , Estudos Cross-Over , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placebos , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Privação do Sono/induzido quimicamente , Resultado do Tratamento , Vigília/efeitos dos fármacos
17.
Eur J Oncol Nurs ; 12(1): 53-7, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17884731

RESUMO

The aim of this cross-sectional study is to investigate demographic and clinical factors that interfere with quality of life (QoL) in women with breast cancer. The sample was composed of 73 women at the mean age of 47.8 (sd=7.8) years and time of disease at 3.08 (sd=3.2) years. For purposes of assessing QoL, we applied the WHOQOL-bref instrument and for detecting depressive symptoms, the Beck Depression Inventory (BDI). Because variables were arranged into temporally related categories, hierarchical multiple linear regression was performed: Group 1 (age and educational background), Group 2 (staging, time of disease, mastectomy and chemotherapy) and Group 3 (BDI). The lowest QoL ratings were associated with mastectomy in the physical (p=0.002) and psychological (p=0.02) domains and depressive symptoms in all domains of WHOQOL-bref (p<0.05). Because QoL assessments are viewed as potentially useful in clinical practice, it is critical that health professionals be alert to patients' depressive symptoms even several years after cancer diagnosis.


Assuntos
Atitude Frente a Saúde , Neoplasias da Mama/psicologia , Depressão/psicologia , Qualidade de Vida/psicologia , Mulheres/psicologia , Atividades Cotidianas/psicologia , Adulto , Idoso , Antineoplásicos/uso terapêutico , Brasil , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Estudos Transversais , Depressão/diagnóstico , Depressão/etiologia , Feminino , Humanos , Modelos Lineares , Mastectomia/psicologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias/psicologia , Pesquisa Metodológica em Enfermagem , Fatores de Risco , Apoio Social , Inquéritos e Questionários , Mulheres/educação
18.
J AAPOS ; 9(5): 449-54, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16213394

RESUMO

PURPOSE: We sought to assess the success of amblyopia treatment in patients with small posterior lens opacities as well as the factors associated with a good visual outcome. METHODS: This was a retrospective study of patients with posterior lens opacities that initially were thought to be too small in size to warrant cataract surgery. The following variables were examined: cataract type, location, diameter, persistent hyaloid vessel, anisometropia, strabismus, and age of detection. Success of treatment of amblyopia was defined as improvement by at least 0.3 logMAR units. Good visual outcome was defined as 20/40 or better. Amblyopia was treated by glasses, patching, and/or atropine. Patients who failed with conservative treatment or had an increase in cataract size underwent surgery. RESULTS: Forty-eight (91%) of 53 eyes were amblyopic. Thirty amblyopic eyes had pre- and post-treatment Snellen acuities. Twenty (67%) had their visual acuity (VA) improved by 0.3 logMAR units or greater. None of the measured variables were associated with successful amblyopia treatment. Twenty-five (49%) of 51 patients had a final VA of 20/40 or better. The only variable associated with good visual outcome was cataract type: 18 of 25 (72%) posterior subcapsular cataract and 6 of 23 (32%) posterior lenticonus eyes achieved VA of 20/40 or better (P = 0.008). Six patients who went on to have cataract surgery experienced a larger improvement in BCVA (4.50 logMar units +/- 2.52 lines) compared with patients treated without cataract surgery (2.36 logMar units +/- 3.11 lines). DISCUSSION: Amblyopia treatment was successful in most cases. A small group of patients who underwent cataract surgery experienced a greater VA improvement; however, it was not statistically significant. Further studies are needed to determine which patients would benefit from cataract surgery.


Assuntos
Ambliopia/terapia , Catarata/complicações , Óculos , Doenças do Cristalino/complicações , Midriáticos/uso terapêutico , Privação Sensorial , Acuidade Visual/fisiologia , Ambliopia/complicações , Ambliopia/fisiopatologia , Atropina/administração & dosagem , Atropina/uso terapêutico , Catarata/terapia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Doenças do Cristalino/terapia , Masculino , Midriáticos/administração & dosagem , Soluções Oftálmicas , Estudos Retrospectivos , Resultado do Tratamento
19.
J Pediatr (Rio J) ; 81(4): 305-9, 2005.
Artigo em Português | MEDLINE | ID: mdl-16106315

RESUMO

OBJECTIVE: To investigate the relationship between the increase of body mass index and the prevalence and severity of asthma in adolescents from Santa Maria, in southern Brazil, and surrounding regions. METHOD: A cross-sectional, observational, population-based study was carried out with 4,010 schoolchildren aged 13 and 14 years, without any gender restrictions, who answered the written questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC) phase III. Body mass index was used (kg/m2) as recommended by the World Health Organization for the assessment of nutritional status: below the fifth percentile (underweight), at or above the fifth percentile and below the 85th percentile (normal weight), at or above the 85th percentile and below the 95th percentile (overweight), and at or above the 95th percentile (obesity). The relationship between body mass index and the prevalence and severity of asthma was analyzed using the chi-square test for trend (statistical significance: p < or = 0.05). RESULTS: There was a significant statistical association between the increase in body mass index and the prevalence of "wheezing ever" (p = 0.036), and "wheezing with exercise" (p = 0.008). When stratified by sex, there was a positive association just for "wheezing ever" (p = 0.028) for boys and "wheezing with exercise" (p = 0.03) for girls. CONCLUSION: The increase in body mass index was associated with the increase in the prevalence of wheezing ever, but not with the increase in the prevalence and severity of asthma among adolescents.


Assuntos
Asma/epidemiologia , Índice de Massa Corporal , Obesidade/complicações , Adolescente , Asma/etiologia , Brasil/epidemiologia , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Obesidade/epidemiologia , Fatores Sexuais
20.
J. pediatr. (Rio J.) ; 81(4): 305-309, jul.-ago. 2005. tab
Artigo em Português | LILACS | ID: lil-414401

RESUMO

OBJETIVO: Investigar a relacão entre o aumento do índice de massa corporal e a prevalência e a gravidade da asma em escolares adolescentes residentes em Santa Maria e região (RS). MÉTODO: Estudo transversal de base populacional, do qual participaram 4.010 adolescentes (13 e 14 anos de idade), sem restricões de sexo, tendo preenchido de forma correta o questionário do International Study of Asthma and Allergies fase III (módulo asma). Utilizou-se o índice de massa corporal (kg/my) com os seguintes percentis (Organizacão Mundial de Saúde) para definir o estado nutricional: abaixo do quinto (desnutricão), igual ou superior ao quinto e inferior ao 85º (normal), igual ou superior ao 85º e inferior ao 95º (sobrepeso), igual ou superior ao 95º (obesidade). Para verificar a associacão entre índice de massa corporal e a prevalência e gravidade da asma, foi utilizado o teste do qui-quadrado para tendência linear, com nível de significância de 5 por cento. RESULTADOS: O aumento do índice de massa corporal mostrou associacão positiva e significante com o da prevalência de "sibilos alguma vez" (p = 0,036) e a de "sibilos após exercício" (p = 0,008), independentemente do sexo. Quando estratificado por gênero, houve associacão positiva apenas para "sibilos alguma vez" (p = 0,028) para meninos e "sibilos após exercício" (p = 0,03) para meninas. CONCLUSAO: O aumento do índice de massa corporal associou-se com o aumento da prevalência de sibilos alguma vez na vida, mas não com o aumento da prevalência e gravidade da asma em adolescentes.


Assuntos
Adolescente , Humanos , Masculino , Feminino , Asma/epidemiologia , Índice de Massa Corporal , Obesidade/complicações , Asma/etiologia , Brasil/epidemiologia , Métodos Epidemiológicos , Obesidade/epidemiologia , Fatores Sexuais
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