Arminda Lucia Siqueira

Factors associated with low quality of life in schizophrenia

Interest in quality of life in mental health care has been stimulated by the deinstitutionalization of psychiatric patients as well as a parallel interest in understanding the scope of their daily lives. This study aims to investigate the socio-demographic and clinical variables related to low quality of life, using a cross-sectional design to evaluate quality of life by means of the QLS-BR scale. We interviewed a sample of 123 outpatients from a reference mental health center in Divinópolis, Minas Gerais State, Brazil, clinically diagnosed with schizophrenia. Univariate and multivariate logistic regression analyses were carried out. The results showed that low quality of life is associated with one or more of the following: male gender, single marital status, low income plus low schooling, use of three or more prescribed psychoactive drugs, psychomotor agitation during the interview, and current follow-up care. The study identifies plausible indicators for the attention and care needed to improve psychiatric patient treatment.

Ordinal logistic regression models: application in quality of life studies

Quality of life has been increasingly emphasized in public health research in recent years. Typically, the results of quality of life are measured by means of ordinal scales. In these situations, specific statistical methods are necessary because procedures such as either dichotomization or misinformation on the distribution of the outcome variable may complicate the inferential process. Ordinal logistic regression models are appropriate in many of these situations. This article presents a review of the proportional odds model, partial proportional odds model, continuation ratio model, and stereotype model. The fit, statistical inference, and comparisons between models are illustrated with data from a study on quality of life in 273 patients with schizophrenia. All tested models showed good fit, but the proportional odds or partial proportional odds models proved to be the best choice due to the nature of the data and ease of interpretation of the results. Ordinal logistic models perform differently depending on categorization of outcome, adequacy in relation to assumptions, goodness-of-fit, and parsimony.

Regressão logística ordinal em estudos epidemiológicos

Ordinal logistic regression models have been developed for analysis of epidemiological studies. However, the adequacy of such models for adjustment has so far received little attention. In this article, we reviewed the most important ordinal regression models and common approaches used to verify goodness-of-fit, using R or Stata programs. We performed formal and graphical analyses to compare ordinal models using data sets on health conditions from the National Health and Nutrition Examination Survey (NHANES II).Os modelos de regressao logistica ordinal vem sendo aplicados com sucesso na analise de estudos epidemiologicos. Entretanto, a verificacao da adequacao de cada modelo tem recebido atencao limitada. O artigo apresenta uma breve analise dos principais modelos de regressao logistica ordinal e as estrategias para ajuste s, as tecnicas de verificacao de qualidade do ajuste, bem como os comandos para execucao nos softwares R e Stata. A metodologia e ilustrada com aplicacao dos dados do Second National Health and Nutrition Examination Survey (NHANES II), o conhecido levantamento de saude e nutricao.

Presentation of congenital heart disease diagnosed at birth: analysis of 29,770 newborn infants

OBJECTIVE To estimate the prevalence rate and study the clinical presentation and associated factors of congenital heart diseases diagnosed at birth between August 1990 and December 2003, at the Maternity Unit of the Hospital das Clínicas, Universidade Federal de Minas Gerais, Brazil. METHODS A retrospective, database driven study, part of the Latin-American collaborative study of congenital malformations. Records were reviewed on all live born (LB) and stillborn (SB) infants with congenital heart diseases diagnosed by postnatal echocardiogram or by autopsy. Data on birth weight, sex, age and parity were collected for the LB and studied for associations. The statistical analysis employed Pearsons chi-square test and multinomial logistic regression. RESULTS During the period studied there were 29,770 births (28,915 LB and 855 SB). The prevalence of heart disease among the LB was 9.58:1,000 (277/28,915) while among SB the rate was 87.72:1,000 (75/855). Heart disease occurred isolated in 37.2% of LB cases and 18.7% of SB cases; was associated with anomalies of other organs and systems, but without a syndromic diagnosis in 31.4% of LB cases and 48.0% of SB cases; and in 23.1% of the LB cases and 32.0% of the SB cases the heart disease was a feature of a syndrome. Multivariate analysis demonstrated an association between heart disease and birth weight <or= 2,500 g in all types of clinical presentation, between maternal age >or= 35 years and heart disease in syndromic heart disease and between female sex and isolated heart disease. CONCLUSIONS It was found a high prevalence, which is an alert to the medical significance of heart disease. There was association between birth weight <or= 2,500 g and all forms of presentation, between increased maternal age and syndromic heart disease besides between female sex and isolated congenital heart disease.

Qualidade de vida e dimensão ocupacional na esquizofrenia: uma comparação por sexo

Schizophrenia has been associated with low quality of life in patients, and the impact can vary by gender. Knowing gender differences may help implement specific interventions. This study focuses on quality of life in male and female outpatients with schizophrenia, particularly examining the occupational domain. A cross-sectional study using the Quality of Life Scale (QLS-BR) was carried out. Comparisons of scores by gender used uni- and multivariate analyses by means of a classification tree through the CHAID algorithm and ordinal logistic regression. Women showed higher quality of life scores (p 5 years) was another significant factor for lower scores. Women had better quality of life scores than men, suggesting that they have more occupational activities due to their greater participation in domestic and social activities.

Apresentação das cardiopatias congênitas diagnosticadas ao nascimento: análise de 29.770 recém-nascidos

OBJECTIVE: To estimate the prevalence rate and study the clinical presentation and associated factors of congenital heart diseases diagnosed at birth between August 1990 and December 2003, at the Maternity Unit of the Hospital das Clinicas, Universidade Federal de Minas Gerais, Brazil. METHODS: A retrospective, database driven study, part of the Latin-American collaborative study of congenital malformations. Records were reviewed on all live born (LB) and stillborn (SB) infants with congenital heart diseases diagnosed by postnatal echocardiogram or by autopsy. Data on birth weight, sex, age and parity were collected for the LB and studied for associations. The statistical analysis employed Pearsons chi-square test and multinomial logistic regression. RESULTS: During the period studied there were 29,770 births (28,915 LB and 855 SB). The prevalence of heart disease among the LB was 9.58:1,000 (277/28,915) while among SB the rate was 87.72:1,000 (75/855). Heart disease occurred isolated in 37.2% of LB cases and 18.7% of SB cases; was associated with anomalies of other organs and systems, but without a syndromic diagnosis in 31.4% of LB cases and 48.0% of SB cases; and in 23.1% of the LB cases and 32.0% of the SB cases the heart disease was a feature of a syndrome. Multivariate analysis demonstrated an association between heart disease and birth weight £ 2,500 g in all types of clinical presentation, between maternal age ³ 35 years and heart disease in syndromic heart disease and between female sex and isolated heart disease. CONCLUSIONS: It was found a high prevalence, which is an alert to the medical significance of heart disease. There was association between birth weight £ 2,500 g and all forms of presentation, between increased maternal age and syndromic heart disease besides between female sex and isolated congenital heart disease.

Hearing loss in congenital toxoplasmosis detected by newborn screening

UNLABELLED Congenital toxoplasmosis may cause sensorineural deficit in up to 20% of the patients and proper treatment in the first year improves prognosis. In Brazil, this infections impact on hearing impairment is unknown. AIM To evaluate hearing of newborns with congenital toxoplasmosis identified by the newborn screening service. METHOD This prospective study analyzed children with congenital toxoplasmosis identified by newborn screening (IgM anti-T.gondii) in Belo Horizonte during 2003/2004. The presence of IgM and/or IgA in the first 6 months or IgG at 12 months-of age in serology was used as case definition. Hearing tests were carried out at the time of diagnosis and 12 months later, including behavioral audiometry, evoked otoacoustic emission and brainstem evoked responses audiometry. RESULTS Among 30.808 screened children (97% of live births), 20 had congenital toxoplasmosis, 15 (75%) were asymptomatic at birth. Nineteen children were evaluated by hearing tests. Four had sensorineural impairment (21.1%). One child had other risk factors for hearing impairment; the other three had no other risk factors but toxoplasmosis. Two properly children treated still had hearing loss, in disagreement with current literature. CONCLUSION Results suggest that congenital toxoplasmosis, common in Brazil, is a risk factor for hearing impairment and its impact on hearing loss deserves further studies.

Ordinal logistic regression in epidemiological studies

Ordinal logistic regression models have been developed for analysis of epidemiological studies. However, the adequacy of such models for adjustment has so far received little attention. In this article, we reviewed the most important ordinal regression models and common approaches used to verify goodness-of-fit, using R or Stata programs. We performed formal and graphical analyses to compare ordinal models using data sets on health conditions from the National Health and Nutrition Examination Survey (NHANES II).Os modelos de regressao logistica ordinal vem sendo aplicados com sucesso na analise de estudos epidemiologicos. Entretanto, a verificacao da adequacao de cada modelo tem recebido atencao limitada. O artigo apresenta uma breve analise dos principais modelos de regressao logistica ordinal e as estrategias para ajuste s, as tecnicas de verificacao de qualidade do ajuste, bem como os comandos para execucao nos softwares R e Stata. A metodologia e ilustrada com aplicacao dos dados do Second National Health and Nutrition Examination Survey (NHANES II), o conhecido levantamento de saude e nutricao.

Depressão na esquizofrenia: prevalência e relação com a qualidade de vida

This study aimed to investigate the prevalence of depression in schizophrenia and associated factors, including quality of life. A cross-sectional study was conducted with 150 outpatients. The Calgary Depression Scale for Schizophrenia measured depression, and the Quality of Life Scale-Brazil measured quality of life. Major depression was found in 56% of patients with schizophrenia. Patients with major depression had low quality of life according to both the global scale and the occupational subscale. Global quality of life was important for separating the decision-tree statistical analyses. In patients with low quality of life, three factors were associated with depression: presence of schizophrenic symptoms, number of medications, and lack of household activities. In patients with better quality of life scores, only duration of the illness was significant. The study shows a high prevalence of depression in schizophrenia, besides highlighting its repercussions on quality of life. When evaluating quality of life, the presence of depression should be taken into consideration.

Dried blood spots as a practical and inexpensive source for human immunodeficiency virus and hepatitis C virus surveillance

Passive surveillance of infectious diseases with a high percentage of asymptomatic cases or long incubation periods, such as acquired immunodeficiency syndrome (AIDS), does not reflect the current transmission dynamics. Thus, a multi-strategic surveillance, such as the human immunodeficiency virus (HIV) sentinel surveillance proposed by the World Health Organization (WHO), is necessary. The Brazilian HIV sentinel surveillance was started in May 1992 with this purpose. The objectives of this study were to evaluate the feasibility and costs of HIV and hepatitis C virus (HCV) surveillance using dried blood spots (DBS) collected for neonatal screening of metabolic diseases in the state of Minas Gerais, Brazil. This was accomplished through the comparison of HIV and HCV seroprevalence with previous Brazilian studies. From December 2001 to June 2002, 24,905 newborns were tested for HIV and 4211 for HCV. HIV seroprevalence was 0.25% and the 95% confidence interval (CI) was 0.18, 0.31%; and HCV seroprevalence was 0.71% and the 95% CI was 0.46, 0.97%. These numbers are similar to previous Brazilian studies. Cost in this study was approximately USD 3.10 per sample, which was roughly one third of the cost of the same exam at the Brazilian HIV sentinel surveillance. We conclude that it is possible and more cost-effective to use DBS for infectious diseases surveillance, albeit it is still necessary to compare these results with the usual sentinel methodology in a concomitant trial.