Carlos Henrique Martins da Silva

Health-related quality of life of medical students

Medical Education 2010: 44 : 227–235

Inter- and intrareader variability in the interpretation of two radiographic classification systems for juvenile rheumatoid arthritis

ObjectiveTo evaluate the inter- and intrareader variability for interpretation of a modified Larsens radiographic classification system for juvenile rheumatoid arthritis (JRA) focused on osteochondral lesions and a conventional Larsens classification system, compared to a reference MR scoring system of corresponding images.Materials and methodsSeventy-five radiographs of 60 children with JRA, performed within a short interval of time from the MR examinations, were independently evaluated by three experienced radiologists, three diagnostic imaging residents and three rheumatologists, in two separate sessions, according to the two different classification methods, blinded to the corresponding MR images.ResultsThe inter- and intrareader concordance rates between the two radiographic classification systems and the MR-related radiographs were respectively poor and poor/moderate. The interobserver range of weighted kappa values for the conventional and the modified Larsens system respectively was 0.25–0.37 vs 0.19–0.39 for radiologists, 0.25–0.37 vs 0.18–0.30 for residents and 0.19–0.51 vs 0.17–0.29 for rheumatologists. The intrareader rate ranged from 0.17–0.55 for radiologists, 0.2–0.56 for residents, and 0.14–0.59 for rheumatologists.ConclusionAlthough the proposal of a new radiographic classification system for JRA focused on osteochondral abnormalities sounds promising, the low inter- and intrareader concordance rates with an MR-related radiographic system makes the clinical applicability of such a radiographic system less suitable.

Macrophage activation syndrome associated with systemic juvenile idiopathic arthritis

OBJECTIVE To describe the characteristics of macrophage activation syndrome associated with juvenile idiopathic arthritis. DESCRIPTION This is a retrospective study involving 462 patients with juvenile idiopathic arthritis. Seven (1.5%) of those patients suffered from systemic onset juvenile idiopathic arthritis and developed macrophage activation syndrome. The median age of the juvenile idiopathic arthritis onset was 3 years and 10 months and the median duration of juvenile idiopathic arthritis before macrophage activation syndrome was 8 years and 4 months. All of them presented with fever, jaundice, hepatosplenomegaly, bleeding, pancytopenia, abnormal liver function tests and abnormal coagulation profile. Three cases presented associated infections and one patient developed macrophage activation syndrome two weeks after the administration of sulfasalazine. Three patients died and the macrophage hemophagocytosis was present in five. The treatment of macrophage activation syndrome included pulse therapy with methylprednisolone in all of them, cyclosporine A in three, plasma exchange in two and intravenous immunoglobulin in two. COMMENTS Macrophage activation syndrome is a complication of the systemic onset juvenile idiopathic arthritis with a high morbidity and mortality rate.

Qualidade de vida em portadores de esclerose múltipla

Propedeutica Neurologica Faculdade de Medicina Universidade Federal de Uberlândia, Uberlândia MG

Effects of Pilates Exercises on Health-Related Quality of Life in Individuals With Juvenile Idiopathic Arthritis

OBJECTIVE To determine the effects of Pilates exercises on health-related quality of life (HRQOL) in individuals with juvenile idiopathic arthritis (JIA). DESIGN Randomized, prospective, single-blind trial. SETTING Outpatient clinic of pediatric rheumatology and the rehabilitation department. PARTICIPANTS Children (N=50) with JIA according to the International League of Associations for Rheumatology criteria. INTERVENTIONS Participants were randomly assigned into 2 groups. In group I (n=25), the participants were given a conventional exercise program for 6 months. Patients in group II (n=25) participated in a Pilates exercise program for 6 months. MAIN OUTCOME MEASURES The primary outcome measure was HRQOL, as measured by the Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0). The secondary outcome measures provided an estimate of the clinical relevance of the primary outcome results and included joint pain intensity (according to a 10-cm visual analog scale), disability (according to the Childhood Health Assessment Questionnaire), joint status (using the Pediatric Escola Paulista de Medicina Range of Motion Scale), and the total PedsQL 4.0 score. RESULTS All participants completed the study. The scores of the PedsQL 4.0 differed significantly between groups, indicating that Pilates exercises increased these scores when compared with the conventional exercise program. Group II participants showed significant improvements in the 10-cm visual analog scale-joint pain, Childhood Health Assessment Questionnaire, and Pediatric Escola Paulista de Medicina Range of Motion Scale. CONCLUSIONS The use of Pilates exercises had a positive physical and psychosocial impact on HRQOL in individuals with JIA. Future multicenter studies with a follow-up beyond the period of treatment using more objective parameters will be useful to support the results of the present study.

Evaluation of the health-related quality of life in elderly patients according to the type of hip fracture: femoral neck or trochanteric

OBJECTIVE To evaluate the effect the type of hip fracture (femoral neck or trochanteric) has on the Health-Related Quality of Life of elderly subjects. METHODS Forty-five patients with hip fractures (mean 74.30 +/- 7.12 years), 24 with a femoral neck fracture and 21 with a trochanteric fracture, completed the 36-item Short Form Health Survey (SF-36) at baseline and four months after fracture. The Health-Related Quality of Life scores were compared according to fracture type, undisplaced and displaced femoral neck fractures, and stable and unstable trochanteric fractures. RESULTS Compared to baseline, all patients scored lower in the physical functioning, role limitation-physical, bodily pain and vitality categories four months after the fracture had occurred. The SF-36 scores for all the scales did not differ significantly between patients with femoral neck versus trochanteric fractures, or between patients with displaced versus undisplaced femoral neck fractures and stable versus unstable trochanteric fractures. CONCLUSIONS The mental and physical quality of life of elderly patients with a hip fracture is severely impaired one month after fracture, with partial recovery by the end of the fourth month. The negative impact on the Health-Related Quality of Life did not differ significantly according to fracture type.

Health-related quality of life and depressive symptoms in undergraduate nursing students

This is a descriptive, cross-sectional study aimed at investigating the health-related quality of life (HRQoL) of nursing students and its relationship with year of training, sociodemographic variables and the intensity of depressive symptoms. A convenience sample of 256 students, out of 353 eligible (72%), responded to the Medical Outcomes Study - The 36 Item Short-Form Health Survey (SF-36) and the Beck Depression Inventory (BDI) (self-administered). Final-year students, females and students with a higher intensity of depressive symptoms presented lower SF-36 scores in the physical functioning, vitality and social functioning domains. Institutional psychopedagogic support programs may minimize this negative impact on the HRQoL and encourage better professional performance of students in higher vulnerability situations.Trata-se de estudo descritivo e transversal, que investigou a qualidade de vida relacionada a saude (QVRS) de estudantes de Enfermagem e a relacao da QVRS com o ano de estudo, as variaveis sociodemograficas e a intensidade de sintomas depressivos. Uma amostra acidental de 256 estudantes dos 353 elegiveis (72%) respondeu ao Medical Outcomes Study - The 36 Item Short-Form Health Survey (SF-36) e ao Inventario de Depressao de Beck (IDB). Estudantes do ultimo ano do curso, sobretudo do sexo feminino e com maior intensidade de sintomas depressivos, apresentaram menores escores do SF-36 nos dominios capacidade funcional, vitalidade e aspectos sociais. O prejuizo na QVRS ocorre sobretudo no ultimo ano do curso, nos estudantes do sexo feminino ou com sintomas depressivos. Programas institucionais de aconselhamento psicopedagogico poderiam minimizar o impacto negativo detectado na QVRS e contribuir para melhor formacao e desempenho profissional dos estudantes em situacao de maior vulnerabilidade.

Deficiência auditiva neurossensorial associada à doença de Kawasaki

Objective: Kawasaki disease is a systemic idiopathic self-limited vasculitis of small and medium-sized vessels. Thirteen cases of sensorineural hearing loss during the evolution of this disease have been described in the literature. We describe a case of an infant with Kawasaki disease who developed sensorineural hearing loss during the acute phase. This case report shows a complication of Kawasaki disease, with few citations in literature, enhancing the importance of careful evaluation of these patients.Description: nineteen-month-old-boy, formerly healthy, with persistent daily fever seven days before admission, associated with irritability, bilateral nonexudative conjunctivitis and maculopapular erythema on his trunk. There was later development of arthritis on wrists, elbows, knees, and ankles, and swelling associated with desquamation of hands and feet, which prevented him from walking. The diagnosis of Kawasaki disease was established according to the American Heart Associations criteria, and the child was conventionally treated. There was regression of clinical manifestations three days after the beginning of treatment. However, one month after the onset of symptoms, the family noticed an unsatisfactory response to sound stimuli. The evaluation of auditory acuity through BERA (Brainstem Evoked Responses Audiometry) revealed severe bilateral sensorineural hearing loss.Comments: routine examination of auditory acuity in children with Kawasaki disease may help identify sensorineural hearing loss at an early stage.

Cross-cultural validation of the Patient–Practitioner Orientation Scale (PPOS)

OBJECTIVES Translate, adapt and validate the Patient-Practitioner Orientation Scale (PPOS) for use in Brazil. METHODS The PPOS was translated to Portuguese using a modified Delphi technique. The final version was applied to 360 participants. Reliability (test-retest and internal consistency) and construct validity (explanatory and confirmatory factor analysis) were assessed. RESULTS Only two items did not reach pre-established criteria agreement in Delphi technique. In pre-testing, seven items were modified. Internal consistency (Cronbachs alpha=0.605) and test-retest reliability (intraclass correlation coefficient=0.670) were adequate. In explanatory factor analysis, one item did not achieve a loading factor, one item was considered factorially complex and two items were inconsistent with a priori factors. Confirmatory factor analysis provided an acceptable adjustment for the observed variables (χ(2)/df=2.33; GFI=0.91; AGFI=0.89; CFI=0.84; NFI=0.75; NNFI=0.81; RMSEA=0.062 (p=0.016) and SRMR=0.065). CONCLUSIONS The Brazilian version PPOS (B-PPOS) showed acceptable validity and adequate reliability. PRACTICE IMPLICATIONS The use of the B-PPOS in national and cross-cultural studies may contribute to the evaluation and monitoring of the attitudes of doctors, medical students and patients toward their professional relationships in research and practice.

Parents' perception of health-related quality of life in children and adolescents with excess weight

Objective To evaluate the perception of parents or caregivers on the health-related quality of life (HRQOL) of children/adolescents with overweight/obesity and possible factors associated with this perception.