Denise Siqueira de Carvalho

Fatigue after treatment in breast cancer survivors: prevalence, determinants and impact on health-related quality of life

PurposeFatigue is a phenomenon that may persist for years after completion of adjuvant therapy, and is one of the most frequent symptoms associated with breast cancer survivors. The purposes of this study were to investigate the occurrence of fatigue in disease-free breast cancer survivors after treatment, to identify variables associated with fatigue, and to evaluate the impact of fatigue on health-related quality of life.MethodsA cross-sectional study was conducted on 202 consecutive women diagnosed with in-situ to Stage III breast cancer attending in outpatient facilities of two large hospitals, one year or more after diagnosis. They completed the Piper Fatigue Scale-Revised and the European Organization for Research and Treatment of Cancer QLQ-C30. Multiple logistic regression models were used to identify predictive factors associated with fatigue. EORTC QLQC-30 scores for fatigued survivors were compared to non-fatigued survivors.ResultsThe prevalence of fatigue reported by the breast cancer survivors was 37.6%. Multiple logistic regression analysis revealed that predictive factors for fatigue included younger age (odds ratio [OR]=2.23, 95% confidence interval [CI]=1.11–4.45, p = 0.024); presence of pain (OR = 3.87, 95% CI = 1.88-7.98, p = 0.000); dyspnea (OR = 3.72, 95% CI = 1.46–9.50, p = 0.006); insomnia (OR = 2.40, 95% CI = 1.19–4.86, p = 0.015); and nausea and vomiting (OR = 12.25, 95% CI = 1.18–126.75, p = 0.036). Fatigued women had poorer health-related quality of life than non-fatigued women in all domains.ConclusionOur results suggest that many disease-free breast cancer survivors after treatment experienced fatigue that compromises their health-related quality of life.

Avaliação da implantação de programa de atenção pré-natal no Município de Curitiba, Paraná, Brasil: estudo em coorte de primigestas

A prenatal care program was evaluated to measure its effectiveness and impact. In 1999 a new prenatal care program was introduced in Curitiba, Paraná State, Brazil, in health services under the Unified National Health System, introducing organizational changes in order to enhance accessibility, increase the number and distribution of prenatal visits, and ensure minimum necessary procedures. To evaluate how these changes were assimilated in routine practice, a cohort study was proposed in a sample of 660 primigravidae randomly selected among women enrolled in the program before the 20th week of gestation, from March to August, 2000. Two home visits and consultation of maternity cards or patient records during prenatal and hospital care were performed. The results indicate good accessibility and professional adherence to the protocol, but problems still remain with initiating care before the end of the first trimester and adequate distribution of consultations. According to the study criteria, adequate care was found for only 38.6% of the women, pointing to the complexity of factors that influence adequate prenatal care.

Mortality rate of adrenocortical tumors in children under 15 years of age in Curitiba, Brazil†

Several reports refer to an increased frequency of adrenal cortex tumors (ACT) among children in Southern Brazil, yet all data have been derived from hospital‐based registries. An inherited germline mutation in the p53 gene (TP53 R337H) is detected in virtually all children with ACT in this region and accounts for the excess cases observed.

Cuidados de enfermagem realizados ao paciente cirúrgico no período pré-operatório

Se trata de un estudio descriptivo y transversal, con un abordaje cuantitativo, realizado en unidades quirurgicas de los hospitales del municipio de Ponta Grossa, que tuvo como objetivo caracterizar los cuidados de enfermeria, realizados en pacientes, durante el periodo preoperatorio de cirugias electivas. La poblacion estudiada, seleccionada por medio de muestra de conveniencia, se constituyo de 129 pacientes, que se encontraban dentro del intervalo de edad de 18 a 70 anos. Para la recoleccion de datos, se utilizo un instrumento estructurado que fue aplicado por medio de una entrevista, en el propio hospital, despues de la cirugia. Los resultados colocaron en evidencia que los cuidados realizados estan dirigidos principalmente a la preparacion fisica del paciente, con pocas orientaciones relacionadas con el procedimiento quirurgico y con los cuidados de enfermeria efectuados. Se percibe que algunos de estos cuidados incomodan a los pacientes, por ejemplo: la colocacion de la camisa quirurgica, la retirada de la ropa intima y de la protesis dentaria. En fin, este estudio permitio que se identificasen fragilidades en el cuidado del paciente quirurgico, en el sentido de contribuir para la reflexion sobre la necesidad de introducir cambios en las practicas de la enfermeria en el ambiente hospitalario.This is a descriptive, cross-sectional, qualitative study performed at the surgical units of two hospitals in the city of Ponta Grossa. The purpose was to characterize the nursing care provided to patients in the pre-surgical period of elective surgeries. The studied population, chosen as a convenience sample, consisted of 129 patients, aged 18 to 70 years. Data collection was performed through structured interviews carried out at the hospital after the surgery. The results show that the care provided is mainly focused on the physical preparation of the patient, in which few instructions are provided about the surgical procedure and the nursing care delivered. It was also observed that some types of nursing care embarrass the patients, such as wearing the surgical gown and removing their underwear and dental prosthetics. Eventually, this study allowed for the identification of weaknesses in the care provided to the surgical patients, so as to contribute for the reflection about the need to make changes in the nursing practices performed in the hospital.

Nursing care applied to surgical patient in the pre-surgical period

Se trata de un estudio descriptivo y transversal, con un abordaje cuantitativo, realizado en unidades quirurgicas de los hospitales del municipio de Ponta Grossa, que tuvo como objetivo caracterizar los cuidados de enfermeria, realizados en pacientes, durante el periodo preoperatorio de cirugias electivas. La poblacion estudiada, seleccionada por medio de muestra de conveniencia, se constituyo de 129 pacientes, que se encontraban dentro del intervalo de edad de 18 a 70 anos. Para la recoleccion de datos, se utilizo un instrumento estructurado que fue aplicado por medio de una entrevista, en el propio hospital, despues de la cirugia. Los resultados colocaron en evidencia que los cuidados realizados estan dirigidos principalmente a la preparacion fisica del paciente, con pocas orientaciones relacionadas con el procedimiento quirurgico y con los cuidados de enfermeria efectuados. Se percibe que algunos de estos cuidados incomodan a los pacientes, por ejemplo: la colocacion de la camisa quirurgica, la retirada de la ropa intima y de la protesis dentaria. En fin, este estudio permitio que se identificasen fragilidades en el cuidado del paciente quirurgico, en el sentido de contribuir para la reflexion sobre la necesidad de introducir cambios en las practicas de la enfermeria en el ambiente hospitalario.This is a descriptive, cross-sectional, qualitative study performed at the surgical units of two hospitals in the city of Ponta Grossa. The purpose was to characterize the nursing care provided to patients in the pre-surgical period of elective surgeries. The studied population, chosen as a convenience sample, consisted of 129 patients, aged 18 to 70 years. Data collection was performed through structured interviews carried out at the hospital after the surgery. The results show that the care provided is mainly focused on the physical preparation of the patient, in which few instructions are provided about the surgical procedure and the nursing care delivered. It was also observed that some types of nursing care embarrass the patients, such as wearing the surgical gown and removing their underwear and dental prosthetics. Eventually, this study allowed for the identification of weaknesses in the care provided to the surgical patients, so as to contribute for the reflection about the need to make changes in the nursing practices performed in the hospital.

Implementation of Virtual Patients in the Training for Occupational Health in Latin America

Abstract Health professionals trained in occupational health are essential to reduce the burden of occupational accidents and diseases. However, training resources are limited globally. We aimed to promote occupational health and safety (OHS) using virtual patients (VPs) in Brazil, Chile, and Germany. Virtual patients were created in three Latin-American health centers. So-called “partner VPs” comparing the distinct health care systems were designed. Translation, adaptation to different medical and legal systems, expert review, implementation into under- and postgraduate teaching, and user evaluation were performed. Twelve VPs covering traditional and contemporary OHS issues are available in Spanish, Portuguese, and English. Overall, 2371 students used the VPs. The number of Latin American users who evaluated VP content and relevance for their professional career was statistically significantly higher than the number of German students. VPs are a feasible learning method for OHS in middle-income countries. Partner VPs seem to be useful for teaching global aspects.

Impacto da terapia antirretroviral conforme diferentes consensos de tratamento da Aids no Brasil

OBJECTIVE Compare the characteristics of AIDS patients and treatment outcomes under three different antiretroviral treatment regimens advocated by the Ministry of Health of Brazil. METHODS Retrospective cohorts of patients who had survived up to five years after diagnosis were constructed. The data were obtained from medical records, medication dispensing forms, and death certificates of patients in Curitiba, in the Brazilian state of Paraná. Six hundred patients were selected from the first six months following the adoption of each of the treatment regimens (1992, 1997, and 2002). RESULTS The ratio of men to women fell from 6.5:1 in 1992 to 1.4:1 in 2002. There was a proportionate rise in the number of people over 50, which increased from 1.4% in 1992 to 9.9% in 2002. The case fatality rate dropped from 81.9% to 33.9% in the period in question. An analysis of those who survived at least five years from the date of diagnosis showed that the percentage of patients treated increased from 46.2% in 1992 to 94.0% in 1997, finishing at 91.7% in 2002. Multivariate analysis yielded a positive and statistically significant association between survival up to five years after an AIDS diagnosis and years of schooling, age group, year of diagnosis, type of antiretroviral therapy, and treatment adherence (all with P < 0.001). CONCLUSIONS Continuous improvement of the antiretroviral therapy recommended by the Ministry of Health had a positive impact on survival. There was an association between case fatality and fewer years of schooling, membership in an older age group, a diagnosis obtained in 1992, the type of antiretroviral therapy, and suboptimal adherence to antiretroviral treatment regimens.

Accelerated phase chronic myeloid leukemia: evaluation of clinical criteria as predictors of survival, major cytogenetic response and progression to blast phase.

Background Published criteria defining the accelerated phase in chronic myeloid leukemia are heterogeneous and little is known about predictors of poor outcome. Methods This is a retrospective study of 139 subjects in the accelerated phase of chronic myeloid leukemia treated with imatinib at a single center in Brazil. The objective was to identify risk factors for survival, major cytogenetic response and progression to blast phase in this population. The factors analyzed were: blasts 10–29%, basophils ≥ 20%, platelets > 1 × 106/μL or <1 × 105/μL and white blood cells > 1 × 105/μL in the peripheral blood, as well as clonal evolution, splenomegaly, hemoglobin < 10 g/dL, time between diagnosis of chronic myeloid leukemia and imatinib treatment, and hematologic toxicity. Results Risk factors for poor survival in multivariate analysis were Grades 3–4 hematologic toxicity (p-value = 0.001), blasts 10–29% (p-value = 0.023), and hemoglobin < 10 g/dL (p-value = 0.04). Risk factors for not achieving major cytogenetic response were blasts 10–29% (p-value = 0.007), hemoglobin < 10 g/dL (p-value = 0.001), and previous use of interferon (p-value = 0.032). Risk factors for progression to the blast phase were hemoglobin < 10 g/dL (p-value = 0.005), basophils ≥ 20% (p-value = 0.023), and time from diagnosis of chronic myeloid leukemia to imatinib treatment > 12 months (p-value = 0.030). Conclusion These data indicate that patients with the above risk factors have a worse prognosis. This information can guide the therapy to be used.

Prevalence and Risk Factors for Hearing Loss in Chilean Shellfish Divers

Background: Diving within artisanal fishing is a profession carried out by many men in coastal communities of southern Chile. These shellfish divers use surface supplied air for breathing. Among potential health threats are occupational accidents, decompression sickness and barotrauma. Repeated middle and inner ear barotrauma and decompression sickness of the ear may result in hearing loss. Objective: To determine the prevalence of hearing loss and related risk factors in artisanal shellfish divers. Methods: A cross–sectional study including 125 male shellfish divers was carried out in a coastal village in southern Chile. Participants were interviewed using a standard Spanish questionnaire adapted for this population. Hearing loss was assessed through audiometry. Any hearing loss, sensorineural hearing loss and other types of hearing loss (conduction, unilateral and mixed) were used as the outcomes. Bivariate and multiple logistic regression models were carried out to identify risk factors for hearing loss. Findings: Median duration on the job was 25 years (range 1–52), 64% of divers had a low level of schooling and 52% reported not knowing how to use decompression tables. Most (86%) of the divers dove deeper than 30 meters exceeding the 20 meters permitted by law. The majority (80%) reported having experienced several episodes of type II decompression sickness during their working life. The prevalence of any type of hearing loss was 54.4%: 29.0% presented sensorineural hearing loss and 25.6% presented other types of hearing impairment. After adjustment for age and other potential risk factors, diving more than 25 years was the main predictor for all kinds of hearing loss under study. Conclusions: Hearing loss is frequent in artisanal shellfish divers and safety measures are limited. Although based on small numbers and lacking an unexposed comparison group, our results suggest the need for community-based interventions.

Effort-Reward Imbalance, Mental Health and Accidents in Offshore PetroleumWorkers

Background: Occupational accidents are an aspect of concern in every industrial sector, including the offshore petroleum industry. Little is known about the associations between psychosocial distress and the prevalence of incidents in this sector. Aim: To evaluate the association between effort-reward imbalance (ERI), psychological distress, and the prevalence of occupational incidents (accidents and near misses) in offshore petroleum workers in Peru. Methods: This cross sectional study included 242 (response rate of 67%) male offshore petroleum workers in a gas and oil petroleum company in Peru. Workers answered the short version of the European Working Condition Survey, the Effort-Reward-Imbalance (ERI) questionnaire; Goldbergs general health questionnaire (GHQ-12) and prevalence of occupational accidents or near-miss were reported. After imputation, the association between psychological distress, working activity and working stability and occupational incidents (accidents or near misses) was assessed. Result: The prevalence of effort-reward imbalance was 30%, fourteen percent reported distress based on GHQ-12. The 12-month prevalence of occupational incidents was 9%. Adjusted odds ratio for incidents was 4.3 (95% CI, 1.3-14.0) for those with psychological distress compared to those without it. Conclusion: Psychological distress was related to the prevalence of occupational incidents in this offshore petroleum population. Actions on employment and working conditions to prevent psychosocial distress and the incidence of mental health problems should be implemented for the prevention of occupational accidents in this industry.