Effects of the transobturator tape procedure on overactive bladder symptoms and quality of life: a prospective study

ABSTRACT Introduction: This study aimed to evaluate the effects of transobturator tape (TOT) on overactive bladder (OAB) symptoms and quality of life. Materials and Methods: Patients with stress-predominant mixed urinary incontinence (MUI) who had undergone TOT procedures were considered candidates for this research. Preoperative assessment included anamnesis, pelvic examination, cough stress test (CST), and validated symptom severity and quality of life (QoL) questionnaires. The primary outcome, improvement and cure rates of OAB symptoms were determined based on the patient's baseline scores in symptom-related questions in OAB-V8. Secondary outcomes included the success rates of SUI, changes in the QoL score and patient satisfaction rates. Results: A total of 104 patients were included in the study. Sixty-two patients underwent TOT placement alone, and 42 patients underwent TOT placement along with prolapse surgery. The mean follow-up period of the patients was 30.47 months range: 13-52 months. At the first-year follow-up, 52 patients (50.0%) and 59 patients (56.7%) reported cure in preoperative urgency and urgency incontinence, respectively. The objective and subjective cure rates were 96.2% and 56.7%, respectively. A total of 80.7% of the cases had a 15-point improvement in QoL scores. Conclusions: MUS is not only a gold standard treatment in SUI but also presents as a promising treatment modality in stress-dominant MUI. Although the improvement rates of OAB symptoms significantly decrease over time, QoL and patient satisfaction rates remain higher than any other treatment in this patient group at the third-year follow-up.

Survey on hypoglycemia among insulin-treated patients with diabetes: The Colombian International Operations Hypoglycemia Assessment Tool population / Encuesta sobre hipoglucemia en pacientes con diabetes tratados con insulina: la población colombiana del International Operations Hypoglycemia Assessment Tool

Abstract Introduction: The non-interventional International Operations Hypoglycemia Assessment Tool (IO-HAT) study assessed the incidence of hypoglycemia in patients with insulin-treated diabetes across nine countries, including a cohort of patients in Colombia. Materials and methods: Hypoglycemia incidence among patients with insulin-treated diabetes was assessed across 26 sites in Colombia. Hypoglycaemic events (any, nocturnal or severe) were reported in self-assessment questionnaires (SAQ) and patient diaries based on capillary blood glucose measurement or symptoms. Retrospective events (severe events 6 months before baseline and any event 4 weeks before baseline) were recorded in SAQ, Part 1, and prospective events (4 weeks from baseline) were recorded in SAQ, Part 2, and patient diaries. Differences in hypoglycemia incidence reported in the retrospective and prospective periods were assessed using two-sided tests. Results: Of the 664 patients assessed, 213 had type 1 diabetes (T1D) and 451 had type 2 diabetes (T2D). Nearly all patients experienced at least one hypoglycaemic event in the prospective period (97.1% T1D; 93.3% T2D). Rates of hypoglycemia (events per person- year, PPY) were higher prospectively than retrospectively for any hypoglycemia (T1 D: 121.6 vs. 83.2, p<0.001; T2D: 28.1 vs. 24.6, p=0.127) and severe hypoglycemia (T 1D: 15.3 vs. 9.2, p=0.605; T 2 D: 9.5 vs. 3.5 p=0.040). Conclusion: These results, the first from a patient-reported dataset on hypoglycemia in insulin-treated patients with diabetes in Colombia, show that patients reported higher rates of any hypoglycemia during the prospective period.

Resumen Introducción. En el estudio no intervencionista International Operations Hypoglycemia Assessment Tool (IO-HAT), se evalúo la incidencia de hipoglucemia en pacientes diabéticos tratados con insulina en nueve países, incluido Colombia. Materiales y métodos. La incidencia de hipoglucemia entre pacientes diabéticos tratados con insulina se evaluó en 26 centros médicos en Colombia. Los episodios de hipoglucemia determinados con base en la medición de la glucemia capilar o en los síntomas se reportaron en el cuestionario de autoevaluación (Self-Assessment Questionnaire, SAQ) y en el diario del paciente. Los episodios retrospectivos (episodios graves y cualquiera ocurrido 6 meses y 4 semanas antes del inicio del estudio, respectivamente) se registraron en el SAQ, parte 1, y los eventos prospectivos (4 semanas desde el inicio), en el SAQ, parte 2, y en el diario del paciente. Las diferencias en la incidencia de la hipoglucemia entre los períodos retrospectivo y prospectivo se evaluaron mediante una prueba de dos colas. Resultados. De los 664 pacientes evaluados, 213 tenían diabetes de tipo 1 y 451 tenían diabetes de tipo 2. Casi todos los pacientes experimentaron al menos un episodio de hipoglucemia en el período prospectivo (97,1 %, diabetes de tipo 1, y 93,3 %, diabetes de tipo 2). Los índices de hipoglucemia (episodios año-persona) fueron mayores prospectivamente que retrospectivamente para cualquier tipo de hipoglucemia (diabetes de tipo 1: 121,6 Vs. 83,2; p<0,001; la diabetes de tipo 2: 28,1 Vs. 24,6; p=0,127) y para la hipoglucemia grave (diabetes de tipo 1: 15,3 Vs. 9,2; p=0,605; diabetes de tipo 2: 9,5 Vs. 3,5; p=0,040). Conclusión. Estos resultados, que constituyen el primer conjunto de datos sobre hipoglucemia informados por pacientes diabéticos colombianos tratados con insulina, evidenciaron tasas más altas para ambos tipos de hipoglucemia durante el período prospectivo.

Cross-cultural adaptation of the Cambridge Pulmonary Hypertension Outcome Review for use in patients with pulmonary hypertension in Colombia / Adaptación transcultural de la escala Cambridge Pulmonary Hypertension Outcome Review en pacientes con hipertensión pulmonar en Colombia

ABSTRACT Objective: To conduct a cross-cultural adaptation of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) as an instrument to evaluate the perception of symptoms, functional limitation, and health-related quality of life (HRQoL) in subjects diagnosed with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) in Colombia. Methods: The adaptation process involved 3 phases: translation, cognitive debriefing interviews, and a validation survey. To evaluate the psychometric properties, we recruited individuals ≥ 18 years of age who had been diagnosed with PAH or CTEPH to take part in the latter two stages of the adaptation process. All individuals were being followed on an outpatient basis by the pulmonary hypertension programs at Hospital Universitario San Ignacio, Fundación Clínica Shaio,and Clínicos IPS, all located in the city of Bogotá, Colombia. Results: A Spanish-language version of the CAMPHOR was developed for use in Colombia. The internal consistency was excellent for the symptoms, functioning, and quality of life scales (Cronbach's alpha coefficients of 0.92, 0.87, and 0.93, respectively). Test-retest reliability was above 0.70. The evaluation of the convergent validity and known group validity of the CAMPHOR scales confirmed that there were moderate and strong correlations with the related constructs of the Medical Outcomes Study 36-item Short-Form Health Survey, version 2, as well as showing their capacity to discriminate disease severity. Conclusions: The Spanish-language version of the CAMPHOR developed for use in Colombia was the result of a translation and cultural adaptation process that allows us to consider it equivalent to the original version, having shown good psychometric properties in the study sample. Therefore, its use to assess the impact of interventions on the HRQoL of patients with PAH or CTEPH is recommended, in research and clinical practice.

RESUMEN Objetivo: Realizar la adaptación transcultural del cuestionario Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) como instrumento para evaluar la percepción de síntomas, la limitación funcional y la calidad de vida relacionada con la salud (CVRS) en una población colombiana de sujetos con diagnóstico de hipertensión arterial pulmonar (HAP) e hipertensión pulmonar tromboembólica crónica (HPTEC). Métodos: Estudio de validación de pruebas de determinación de precisión y propiedades psicométricas desarrollado en 3 fases: traducción con adaptación cultural mediante panel bilingüe, aplicación inicial y general para la evaluación de características psicométricas en una cohorte de pacientes > 18 años, con diagnóstico de HAP e HPTEC, en seguimiento por consulta externa de programas de hipertensión pulmonar del Hospital Universitario San Ignacio, Fundación Clínica Shaio y Clínicos IPS. Resultados: Se obtuvo una versión en castellano de la escala CAMPHOR. La consistencia interna observada para los dominios de síntomas, actividades y calidad de vida (valores del coeficiente alfa de Cronbach de 0,92, 0,87 y 0,93 respectivamente) fue adecuada. La confiabilidad prueba-reprueba estuvo por encima de 0,70 y la evaluación de la validez convergente y de grupos conocidos de las subescalas confirmó las correlaciones moderadas y fuertes con constructos relacionados del SF36v2, así como la capacidad discriminatoria según la severidad de la enfermedad. Conclusiones: La versión en castellano de la escala CAMPHOR presentó un proceso de traducción lingüística y adaptación cultural que permite considerarla equivalente a la versión original, demostrando adecuadas propiedades psicométricas en la muestra estudiada. Por ello se recomienda su utilización tanto en la investigación como en la práctica clínica, con el fin de evaluar el impacto de las intervenciones en la CVRS.

Ferramentas para avaliação e acompanhamento da urticária crônica / Patient-reported outcomes for the evaluation and follow-up of chronic urticaria

Urticária é uma doença pruriginosa da pele na qual ocorrem urticas e/ou angioedema. A urticária é definida como crônica quando persiste por 6 semanas ou mais. A urticária crônica tem um grande impacto na vida diária do paciente. Atualmente, não há biomarcadores confiáveis para identificar e medir a atividade da doença na urticária crônica espontânea. Consequentemente, o uso de ferramentas conhecidas por patient-reported outcomes (PROs) é crucial ao avaliar e monitorar diferentes aspectos da urticária crônica, como atividade/gravidade da doença, controle da doença e qualidade de vida. Apresentamos uma visão geral de cinco PROs usados na avaliação da urticária crônica, e destacamos suas vantagens, limitações e uso na prática clínica e pesquisa.

Urticaria is an itching skin disease characterized by the presence of wheals and/or angioedema. Urticaria is defined as chronic when it persists for 6 weeks or more. Chronic urticaria has great impact on the daily lives of patients. Currently, there are no reliable biomarkers to identify and measure disease activity in chronic spontaneous urticaria. Consequently, the use of tools known as patient-reported outcomes (PROs) is crucial when evaluating and monitoring different aspects of chronic urticaria such as disease activity/severity, disease control, and quality of life. We present an overview of the five PROs used in the evaluation of chronic urticaria, highlighting their advantages, limitations, and use in clinical practice and research.

Exploratory and confirmatory factorial analysis of the OHIP-Edent instrument

Abstract Several instruments have been used to measure oral health-related quality of life (OHRQoL). The Oral Health Impact Profile (OHIP) questionnaire was based on the concept that sequential events related to oral diseases can cause discomfort, functional limitations and consequently, result in dysfunctions and even disabilities. There are few studies in the literature that structurally analyze the instruments to verify whether they measure the requirements to which they were designed to. The objective of the study was to evaluate the internal structure of the OHIP-Edent questionnaire. The OHIP-Edent was administered to 54 edentulous patients' wearers of conventional complete dentures. For structural analysis, an exploratory factorial analysis (EFA) was carried out. After determining the internal consistency of the model (Cronbach's alpha = 0.88), the fit was checked using the root mean square error approach (value 0.04), the comparative fit index (value 0.982) and the Tucker-Lewis index (value 0.976). After analysis of the 19 questions and the seven domains proposed in the OHIP-Edent questionnaire, the hypothetical factorial model showed three dimensions denominated "Physical Impact", "Psychological Impact" and "Social Impact". In this sample of conventional complete denture wearers, the OHIP-Edent seems adequate to measure the "Physical Impact", "Psychological Impact", and "Social Impact" of the OHRQoL. The confirmatory factorial analysis confirmed the model and, through adjustment indexes, it was verified that the three dimensions have convergence and consistence adequate in order to characterize the OHRQoL construct with validity.

Active health Ombudsman service: evaluation of the quality of delivery and birth care / Ouvidoria ativa em saúde: avaliação da qualidade da atenção ao parto e nascimento

ABSTRACT OBJECTIVE To evaluate the active health Ombudsman service as an instrument to evaluate the quality of delivery and birth care in the Cegonha Network of the Federal District of Brazil. METHODS This is a cross-sectional study of the telephone survey type carried out with 1,007 mothers with deliveries between October 15, 2013 and November 19, 2013 in the twelve public maternity hospitals that make up the Cegonha Network of the Federal District of Brazil. The instrument has 25 multiple choice or Likert scale questions, including sociodemographic data and acceptability evaluation in five domains: accessibility, relationship between the patient and health professionals, conditions of the structure of the service, information to the patient, and equity and opinion of the patient. We have studied qualitative or categorical variables according to the frequency and distribution of proportions. We have used the score transformed into a scale from zero to 100 for the analysis of the Likert-type scale questions. Results have been expressed as mean and standard deviation. RESULTS Access to prenatal appointments was evaluated as good or excellent by 86.1% of the participants and laboratory tests was evaluated as good or excellent by 85.2% of them. The access to imaging tests was evaluations as good or excellent by 45.7% of the women; 79.5% of the interviewees had their delivery in the maternity hospital where they sought initial care and 18.3% received a home visit by a community health agent after discharge. Most women reported that newborns were placed skin-to-skin immediately after birth, 48.9% had a companion at the time of the delivery, 76.3% were advised about the first appointment of the newborn, and 94.8% were advised on breastfeeding in the maternity hospital. Regarding the evaluation of health professionals, 85.9% of the women considered reception and cordiality as good or excellent at the prenatal care and 94.8% considered it as good or excellent at the maternity hospital. CONCLUSIONS The active health Ombudsman service has contributed to evaluate the quality of public management by allowing the incorporation of the perspective of users of the health service in the evaluation of the acceptability of the Cegonha Network in the Federal District of Brazil.

RESUMO OBJETIVO Avaliar a ouvidoria ativa em saúde como ferramenta de avaliação da qualidade da atenção ao parto e nascimento da Rede Cegonha do Distrito Federal. MÉTODOS Estudo transversal, do tipo inquérito por via telefônica, em 1.007 puérperas com partos realizados entre 15/10/2013 e 19/11/2013, nas 12 maternidades públicas que compõem a Rede Cegonha no Distrito Federal. O instrumento continha 25 questões de múltipla escolha ou do tipo escala Likert, que incluiu dados sociodemográficos e avaliação da aceitabilidade em cinco domínios: acessibilidade, relacionamento entre o paciente e os profissionais de saúde, condições da estrutura do serviço, informação ao paciente, e equidade e opinião do paciente. Variáveis qualitativas ou categóricas foram estudadas de acordo com a frequência e distribuição de proporções. Utilizou-se o escore transformado para uma escala de zero a 100 para análise das questões do tipo escala Likert. Resultados foram expressos em média e desvio-padrão. RESULTADOS O acesso às consultas de pré-natal foi avaliado como bom ou ótimo por 86,1% das participantes e os exames laboratoriais como bom ou ótimo por 85,2%. O acesso aos exames de imagem teve 45,7% avaliações boas ou ótimas; 79,5% das entrevistadas realizaram o parto na maternidade onde buscaram atendimento inicial e 18,3% receberam visita domiciliar por agente comunitário de saúde após a alta. A maioria relatou que os recém-nascidos foram colocados em seus colos ou peitos imediatamente após o nascimento, 48,9% tiveram presença de acompanhante no momento do parto, 76,3% foram orientadas em relação à primeira consulta dos recém-nascidos e 94,8% sobre aleitamento materno na maternidade. Quanto à avaliação dos profissionais de saúde, 85,9% das mulheres consideraram o acolhimento e a cordialidade recebidos como bons ou ótimos no pré-natal e 94,8%, como bons ou ótimos na maternidade. CONCLUSÕES A ouvidoria ativa em saúde contribuiu para a avaliação da qualidade da gestão pública, possibilitando a incorporação da perspectiva das usuárias do serviço de saúde na avaliação da aceitabilidade da Rede Cegonha no Distrito Federal.

Quality of life and urolithiasis: the patient - reported outcomes measurement information system (PROMIS)

ABSTRACT Background: With a high rate of recurrence, urolithiasis is a chronic disease that impacts quality of life. The Patient Reported Outcomes Measurement Information System is an NIH validated questionnaire to assess patient quality of life. We evaluated the impact of urolithiasis on quality of life using the NIH-sponsored PROMIS-43 questionnaire. Materials and Methods: Patients reporting to the kidney stone clinic were interviewed to collect information on stone history and demographic information and were asked to complete the PROMIS-43 questionnaire. Quality of life scores were analyzed using gender and age matched groups for the general US population. Statistical comparisons were made based on demographic information and patient stone history. Statistical significance was P<0.05. Results: 103 patients completed the survey. 36% of respondents were male, the average age of the group was 52 years old, with 58% primary income earners, and 35% primary caregivers. 7% had never passed a stone or had a procedure while 17% passed 10 or more stones in their lifetime. Overall, pain and physical function were worse in patients with urolithiasis. Primary income earners had better quality of life while primary caregivers and those with other chronic medical conditions were worse. Patients on dietary and medical therapy had better quality of life scores. Conclusions: Urolithiasis patients subjectively have worse pain and physical function than the general population. The impact of pain on quality of life was greatest in those patients who had more stone episodes, underscoring the importance of preventive measures. Stone prevention measures improve quality of life.

Inadequate pain relief among patients with primary knee osteoarthritis / Alívio inadequado da dor em pacientes com osteoartrite de joelho primária

ABSTRACT Background: Despite the widespread treatments for osteoarthritis (OA), data on treatment patterns, adequacy of pain relief, and quality of life are limited. The prospective multinational Survey of Osteoarthritis Real World Therapies (SORT) was designed to investigate these aspects. Objectives: To analyze the characteristics and the patient reported outcomes of the Portuguese dataset of SORT at the start of observation. Methods: Patients ≥50 years with primary knee OA who were receiving oral or topical analgesics were eligible. Patients were enrolled from seven healthcare centers in Portugal between January and December 2011. Pain and function were evaluated using the Brief Pain Inventory (BPI) and WOMAC. Quality of life was assessed using the 12-Item Short Form Health Survey (SF-12). Inadequate pain relief (IPR) was defined as a score >4/10 on item 5 of the BPI. Results: Overall, 197 patients were analyzed. The median age was 67.0 years and 78.2% were female. Mean duration of knee OA was 6.2 years. IPR was reported by 51.3% of patients. Female gender (adjusted odds ratio - OR 2.15 [95%CI 1.1, 4.5]), diabetes (OR 3.1 [95%CI 1.3, 7.7]) and depression (OR 2.24 [95%CI 1.2, 4.3]) were associated with higher risk of IPR. Patients with IPR reported worst outcomes in all dimensions of WOMAC (p < 0.001) and in all eight domains and summary components of SF-12 (p < 0.001). Conclusions: Our findings indicate that improvements are needed in the management of pain in knee OA in order to achieve better outcomes in terms of pain relief, function and quality of life.

RESUMO Antecedentes: Apesar dos tratamentos muito difundidos para a osteoartrite (OA), dados sobre os padrões de tratamento, a adequação do alívio da dor e a qualidade de vida são limitados. O estudo multinacional prospectivo Survey of Osteoarthritis Real World Therapies (SORT) foi projetado para investigar esses aspectos. Objetivos: Analisar as características e os desfechos relatados pelo paciente do conjunto de dados português do Sort no início da observação. Métodos: Consideraram-se elegíveis os pacientes com 50 anos ou mais com OA de joelho primária que recebiam analgésicos orais ou tópicos. Os pacientes foram recrutados de sete centros de saúde de Portugal entre janeiro e dezembro de 2011. A dor e a função foram avaliadas pelo Brief Pain Inventory (BPI) e pelo WOMAC. A qualidade de vida foi avaliada com o 12-item Short Form Health Survey (SF-12). O alívio inadequado da dor (AID) foi definido como uma pontuação > 4/10 no item 5 do BPI. Resultados: Foram analisados 197 pacientes. A idade média foi de 67 anos e 78,2% eram do sexo feminino. A duração média da OA de joelho foi de 6,2 anos. O AID foi relatado por 51,3% dos pacientes. O sexo feminino (odds ratio ajustado - OR 2,15 [IC 95% 1,1-4,5]), o diabetes (OR = 3,1 [IC 95% 1,3-7,7]) e a depressão (OR 2,24 [IC 95% 1,2-4,3]) estiveram associados a um maior risco de AID. Os pacientes com AID relataram piores desfechos em todas as dimensões do Womac (p < 0,001) e em todos os oito domínios e nos dois componentes sumários do SF-12 (p < 0,001). Conclusões: Os resultados do presente estudo indicam que é necessário melhorar o manejo da dor na OA de joelho a fim de alcançar melhores desfechos em termos de alívio da dor, função e qualidade de vida.

Patient-reported measures of quality of life and functional capacity in adhesive capsulitis / Medidas relatadas pelos pacientes sobre qualidade de vida e capacidade funcional em capsulite adesiva

Summary Objective: To evaluate patient-reported measures of quality of life and functional capacity in adhesive capsulitis before and after suprascapular nerve block treatment; to analyze the influence of clinical and sociodemographic variables on both the outcome and correlation between the respective instruments. Method: A prospective clinical study was performed with adhesive capsulitis patients. Inclusion criteria were clinical diagnosis of adhesive capsulitis and a shoulder imaging test. The WHOQOL-BREF and DASH instruments were administered before and after treatment. A Constant test score of 55 points was used as a cutoff point for discontinuation of treatment. Mean values were compared using paired t-test and Wilcoxon. The Pearson or Spearman coefficients were used for correlation analysis. Multiple linear regression analysis was carried out using variables with p<0.20 as predictors in univariate analysis and WHOQOL domains and DASH as outcomes. The significance level was 5%. Results: Forty-three patients were evaluated. The comparison between WHOQOL-BREF and DASH mean values before and after the blocks, p<0.05. DASH correlated negatively with the physical, psychological and environmental WHOQOL-BREF domains. Older patients and those with higher levels of education influenced the improvement in patients' quality of life and functional capacity. Conclusion: The improvement of adhesive capsulitis with treatment involves an improvement in quality of life and functional capacity. The greater functional capacity of the shoulder matches a better quality of life for patients. Age and education level are the variables that most influence improvement in quality of life and functional capacity.

Resumo Objetivo: Avaliar as medidas relatadas pelos pacientes sobre qualidade de vida e capacidade funcional em capsulite adesiva antes e após tratamento com bloqueios do nervo supraescapular; analisar a influência das variáveis clínicas e sociodemográficas em ambos os desfechos e a correlação entre os respectivos instrumentos. Método: Estudo clínico prospectivo foi realizado em pacientes com capsulite adesiva. Os critérios de inclusão foram diagnóstico clínico de capsulite adesiva e realização de exames de imagem do ombro. Os instrumentos WHOQOL-BREF e DASH foram aplicados antes e após o tratamento. Utilizou-se o escore de Constant com ponto de corte em 55 para a interrupção do tratamento. As médias dos valores foram comparadas pelos testes t-pareado e Wilcoxon. Na análise de correlação foi utilizado o coeficiente de Pearson ou de Spearman. Foi realizada análise de regressão linear múltipla utilizando como preditoras as variáveis com p<0,20 na análise univariada e como desfechos os domínios do WHOQOL e o DASH. O nível de significância foi de 5%. Resultados: Foram avaliados 43 pacientes. A comparação entre as médias dos valores do WHOQOL-BREF e DASH antes e após os bloqueios apresentou um p<0,05. Houve correlação negativa entre o DASH e os domínios físico, psicológico e ambiental do WHOQOL-BREF. Os pacientes mais velhos e com maior grau de escolaridade influenciaram a melhora da qualidade de vida e capacidade funcional dos pacientes. Conclusão: A melhora da capsulite adesiva com o tratamento implica melhora da qualidade de vida e capacidade funcional. Quanto maior a capacidade funcional do ombro, melhor a qualidade de vida dos pacientes. A faixa etária e o grau de escolaridade são as variáveis que mais influenciam a melhora da qualidade de vida e capacidade funcional.

Assessment of satisfaction and Quality of Life using self - reported questionnaires after urethroplasty: a prospective analysis

ABSTRACT Objectives To assess patient satisfaction and quality of life after urethroplasty using two different self-reported outcome measures and to compare it with objective clinical data. Materials and Methods We prospectively collected data from 35 consecutive patients who underwent urethroplasty from January 2013 to September 2014. Patient demographics, International Prostate Symptom Score (IPSS), quality of life score, urethral stricture surgery patient-reported outcome measure (USS-PROM), maximum flow rate (Qmax) and post-void residual urine were collected before, two and eight months after surgery. Failure occurred when any postoperative instrumentation was performed. General estimation equation was used to compare the results and linear regression analysis to correlate both questionnaires with objective data. Results Mean age was 61 years. Urethroplasties were equally divided between anastomotic and buccal mucosa grafts and 19 patients (59.3%) had a previous urethral procedure. Overall success rate was 87.5%. IPSS improved from a mean 19 at baseline to 5.32 at 8 months (p <0.001). The mean USS-PROM score also improved from 13.21 preoperatively to 3.36 after surgery (p <0.001) and 84.3% of patients were satisfied or very satisfied with surgical results. Mean Qmax increased from 4.64mL/s to 11mL/s (p <0.001). Strong negative correlation was found respectively between flow rate and USS-PROM (r=-0.531, p <0.001) and with IPSS (r=-0.512, p <0.001). Conclusions Significant improvements in urinary symptoms and in quality of life are expected after urethroplasty and they are correlated with objective measures.

Fatores associados à percepção de melhora por usuários de Centros de Atenção Psicossocial do Sul do Brasil / Factors associated with perception of improvement by users of Centers for Psychosocial Care in the South of Brazil / Factores asociados a la percepción de mejora por parte de usuarios de Centros de Atención Psicosocial del sur de Brasil

Este estudo objetivou investigar os fatores associados à melhora percebida pelos usuários de Centros de Atenção Psicossocial (CAPS). Estudo transversal, realizado com 1.493 usuários de CAPS do Sul do Brasil. A melhora percebida pelos participantes foi avaliada pela Escala de Mudança Percebida - Pacientes (EMP-Pacientes). Para investigação dos fatores associados, muniu-se de uma regressão logística guiada por um modelo hierárquico que considerou como associação um valor de p < 0,05. Os fatores associados ao desfecho foram: estado de alocação do CAPS, possuir trabalho remunerado, diagnóstico de esquizofrenia, menor idade quando diagnosticado, maior tempo de frequência no serviço, facilidade de acesso e envolvimento na avaliação. Entre os fatores que efetivamente tencionam melhora nos usuários, destacam-se aqueles referentes às características da doença e os aspectos relativos aos serviços quanto à execução das políticas de saúde mental e quanto à organização deles.

This study aimed to investigate factors associated with perceived improvement among users of Centers for Psychosocial Care. This was a cross-sectional study of 1,493 users of Centers for Psychosocial Care in the South of Brazil. Users' perceived improvement was assessed by Perceived Change Scale - Patients (PCS-Patients). Associated factors were investigated using logistic regression guided by a hierarchical model, with statistical significance set at p < 0.05. Factors associated with the outcome were: state where the Center for Psychosocial Care was located, paid work, diagnosis of schizophrenia, age at diagnosis < 18 years, longer time attending the center, ease of access, and involvement in the evaluation. The factors that actually involve improvement in users include those pertaining to characteristics of the illness and aspects related to services in the implementation of mental health policies and their organization.

Este estudio tuvo como objetivo investigar los factores asociados a la mejora percibida por los usuarios de Centros de Atención Psicosocial. Estudio transversal, realizado con 1.493 usuarios de Centros de Atención Psicosocial del sur de Brasil. La mejora percibida por los participantes se evaluó mediante la Escala de Cambios Percibidos - Pacientes (EMP-Pacientes, por sus siglas en portugués). Para la investigación de los factores asociados, se hizo uso de una regresión logística guiada por un modelo jerárquico que consideró como asociación un valor de p < 0,05. Los factores asociados al desenlace fueron: estado de asignación del Centro de Atención Psicosocial, tener trabajo remunerado, diagnóstico de esquizofrenia, menor de edad cuando se es diagnosticado, mayor tiempo de frecuencia en el servicio, facilidad de acceso y participación en la evaluación. Entre los factores que efectivamente prevén mejora en los usuarios, se destacan aquellos referentes a las características de la enfermedad y los aspectos relativos a los servicios, en cuanto a la ejecución de las políticas de salud mental y respecto a la organización de los mismos.

Atribución de malos tratos en servicios de salud a discriminación y sus consecuencias en pacientes diabéticos mapuche / Healthcare mistreatment attributed to discrimination among mapuche patients and discontinuation of diabetes care

Background: The negative impact of perceived discrimination on health outcomes is well established. However, less attention has been directed towards understanding the effect of perceived discrimination on health behaviors relevant for the treatment of diabetes in ethnic minorities. Aim: To examine the effects of healthcare mistreatment attributed to discrimination on the continuity of Type 2 Diabetes (DM2) care among mapuche patients in a southern region of Chile. Material and Methods: A non-probabilistic sample of 85 mapuche DM2 patients were recruited from public and private health systems. Eligibility criteria included having experienced at least one incident of interpersonal healthcare mistreatment. All participants answered an instrument designed to measure healthcare mistreatment and continuity of diabetes care. Results: Healthcare mistreatment attributed to ethnic discrimination was associated with the discontinuation of diabetes care. Conclusions: Healthcare mistreatment attributed to discrimination negatively impacted the continuity of diabetes care, a fact which may provide a better understanding of health disparities in ethnic minorities.