Eduardo de Paula Lima

Avaliação do funcionamento psicossocial na esclerose múltipla: características psicométricas de quatro medidas de auto-relato

Assessment of psychosocial functioning in multiple sclerosis: psychometric characteristics of four self-report measures ABSTRACT - Major and subsyndromic depression are highly prevalent in multiple sclerosis(MS). Assessment of psychosocial functioning in MS requires sound psychometric instruments. Self-report measures offer several advantages, but a valid and reliable depression self-report diagnostic measure is lacking. Beck Depression Inventory (BDI) and General Health Questionnaire (GHQ) have been validated and widely used in Brazilian neuropsychological context. BDI use in MS may confound depressive symptoms with somatic disease manifestations. We examined the psychometric properties of the BDI, QSG and two additional self-report measures of fatigue (CPF-MS) and self-efficacy (MSSE). All scales presented excellent reliability coefficients. BDI and GHG discrimanted MS from control participants. Intercorrelations were observed between depression, general mental health, fatigue and self-efficacy scores, but not between these and traditional indices of neurological impairment such as AI and EDSS. Depressive symptoms and fatigue may represent a different dimension of neurological impairment, unrelated to sensory and motor deficits. Self-report scales are useful in diagnosing subsyndromic distress symptoms in a MS sample.

Prevalence and factors associated with Posttraumatic Stress Disorder (PTSD) in emergency workers: a systematic literature review

OBJETIVO: Identificar as prevalencias de Transtorno de Estresse Pos-Traumatico (TEPT) em profissionais dos servicos de emergencias e conhecer os fatores associados ao desfecho. METODOS: Foram consultadas sete bases de dados (MEDLINE via Pubmed, PsycINFO, LILACS, SciELO, BDENF, DISASTRES e MEDCARIB) entre os dias 10 e 25 de setembro de 2009, restringindo-se a pesquisa a artigos em portugues, ingles ou espanhol publicados no periodo de 2004 a 2009. Os descritores utilizados abarcaram termos relacionados a profissionais/servicos de emergencia, transtorno de estresse pos-traumatico e condicoes de trabalho e saude ocupacional. Foram incluidos estudos observacionais quantitativos que investigaram a prevalencia de TEPT e fatores determinantes ou associados a doenca em amostras de bombeiros, profissionais de ambulância, profissionais da Cruz Vermelha e profissionais de emergencia em hospitais. Foram excluidos estudos com base em amostras inadequadas para os objetivos da revisao (policiais, voluntarios e filhos de profissionais de emergencia) ou que nao incluiram sintomas de TEPT como variavel dependente em pelo menos um dos objetivos. RESULTADOS: A leitura dos titulos e resumos resultou em 30 artigos. A revisao das publicacoes completas permitiu a inclusao e analise de 17 artigos. Os estudos selecionados adotaram diferentes delineamentos, instrumentos, criterios diagnosticos e tecnicas estatisticas de analise. A prevalencia da doenca variou da ausencia de registro de casos a taxa de 38,5%. Caracteristicas sociodemograficas, biologicas e psicologicas, morbidade, exposicao a eventos traumaticos ocupacionais e nao-ocupacionais, e caracteristicas do trabalho e do emprego associaram-se ao TEPT em profissionais de emergencia. CONCLUSAO: Variaveis individuais e de contexto sao consideradas fatores associados ou de risco para o TEPT e explicitam o carater mutidimensional do desfecho em foco.

Perfil cognitivo, déficits motores e influência dos facilitadores para reabilitação de crianças com disfunções neurológicas

OBJETIVO: Investigar se criancas e adolescentes saudaveis e com doencas neurologicas podem ser reunidas em grupos distintos e homogeneos, usando como criterios o desempenho cognitivo, o funcionamento motor e as percepcoes dos pais quanto aos facilitadores para a reabilitacao. METODOS: Participaram deste estudo 15 criancas saudaveis (C) e 43 pacientes (28 com paralisia cerebral e 15 com acidente vascular cerebral), entre cinco e 18 anos. Foi aplicado aos pais o instrumento denominado Avaliacao dos Fatores Ambientais relacionados a Reabilitacao Neurologica Infantil (AFARNI). O comprometimento cognitivo foi avaliado por meio do Mini-Exame do Estado Mental, adaptado para essa faixa etaria, e o comprometimento motor foi investigado por avaliacao clinica. Para comparar os resultados, foi realizada uma analise de conglomerados e ANOVA. RESULTADOS: A analise de conglomerados identificou quatro grupos de pacientes com caracteristicas clinicas e sociodemograficas distintas, confirmados pela ANOVA (p<0,001). Houve dissociacao entre os grupos com relacao ao comprometimento cognitivo e motor. Os pais de criancas com maior comprometimento avaliaram de forma mais positiva os facilitadores para a reabilitacao. CONCLUSOES: A qualificacao dos facilitadores para a reabilitacao por meio da AFARNI e a avaliacao cognitiva com auxilio do Mini-Exame do Estado Mental podem contribuir para identificar as necessidades de suporte para criancas com deficiencias neurologicas que apresentam comprometimento cognitivo e motor.

Desenvolvimento da versão brasileira da Multiple Sclerosis Funcional Composite Measure (MSFC-BCTRIMS): estudo piloto

Initial efforts are reported to develop and validate a Brazilian version of the Multiple Sclerosis Functional Composite Measure (MSFC-BCTRIMS). MSFC is an outcome measure in multiple sclerosis (MS) which assesses motor functions of legs and arms/hands besides cognitive function. MSFC was designed to have better sensitivity and sounder psychometric foundations than traditional measures in detecting therapeutic benefits of disease-modifying agents. Results from the pilot study indicate that the MSFC-BCTRIMS discriminates between MS individuals and a control group. An initial approach to construct validation, intercorrelating the MSFC-BCTRIMS scores with several other measures, suggests speed of information processing is important for both arm/hand and cognitive function.

Maintaining quality of life in multiple sclerosis: fact, fiction, or limited reality?

Health-related quality of life (HRQOL) is an important marker for health-related impacts on individuals with chronic diseases. This HRQOL study compares multiple sclerosis (MS) patients to a socio-demographically-matched healthy control group. HRQOL was assessed by means of a modular instrument (DEFU/DEFIS), which allows comparisons between diseased and healthy individuals. Main goal of the study was to obtain pertinent data to build a more reliable theoretical framework concerning HRQOL in MS. Another aim was to test the hypothesis of the so-called happiness paradox, according to which disabled individuals could maintain reasonable levels of HRQOL. Results show that MS individuals present lower levels of HRQOL in comparison to healthy controls, arguing against the happiness paradox hypothesis. Preservation of HRQOL levels against certain levels of disability may be restricted to a group of patients.

Tabagismo e estressores ocupacionais em bombeiros, 2011

OBJECTIVE To analyze the prevalence of smoking in firefighters and associated factors. METHODS Cross sectional study of 711 firefighters in Belo Horizonte, MG, Southeastern Brazil, in 2011. The data were obtained using a self-applied structured questionnaire, which included sociodemographic characteristics, occupational stressors, health status and adverse life events. Smoking was analyzed as a dichotomous variable (multiple logistic regression). RESULTS The prevalence of smoking among firefighters was 7.6%. Currently smoking status was associated with low levels of schooling, a monthly income in the middle band, the existence of psychiatric problems in the past, high exposure to traumatic events in life, social discrimination, occupational stressors and low demand at work. CONCLUSIONS The low prevalence of smoking indicates the relevance of employment conditions in explaining harmful habits and health. Organizational and operational stressors contribute independently to explaining current smoking status in the population studied.OBJECTIVE To analyze the prevalence of smoking in firefighters and associated factors. METHODS Cross sectional study of 711 firefighters in Belo Horizonte, MG, Southeastern Brazil, in 2011. The data were obtained using a self-applied structured questionnaire, which included sociodemographic characteristics, occupational stressors, health status and adverse life events. Smoking was analyzed as a dichotomous variable (multiple logistic regression). RESULTS The prevalence of smoking among firefighters was 7.6%. Currently smoking status was associated with low levels of schooling, a monthly income in the middle band, the existence of psychiatric problems in the past, high exposure to traumatic events in life, social discrimination, occupational stressors and low demand at work. CONCLUSIONS The low prevalence of smoking indicates the relevance of employment conditions in explaining harmful habits and health. Organizational and operational stressors contribute independently to explaining current smoking status in the population studied.

Desenvolvimento bem-sucedido com esclerose múltipla: um ensaio em psicologia positiva

Successful development with multiple sclerosis: an essay in positive psychology. The chronic and progressively incapacitating nature of many neurological illnesses, such as multiple sclerosis, poses major challenges to the rehabilitative efforts. Approaches based solely on the pursuit of functional restitution incur the risk of failure and additional distress to the sufferers. Compensatory approaches have been consistently shown effective in the empowerment of individuals both to cope with daily life in the short run and to plan their life courses in the long run, thus regaining control and autonomy and improving well being. Compensation requires the establishment of a positive agenda. In this essay we establish a parallel between the processes of psychosocial adaptation to multiple sclerosis and normal adult development. Both similarities and differences are noted. We try to explore some perspectives derived from research models designed to study successful adult development in order to establish a positive agenda for individuals with multiple sclerosis.

Transtorno de Estresse Pós-Traumático (TEPT) em Bombeiros de Belo Horizonte, Brasil: Prevalência e Fatores Ocupacionais Associados

O objetivo do presente estudo foi estimar a prevalencia de Transtorno de Estresse Pos-Traumatico (TEPT) e investigar se variaveis ocupacionais estao associadas ao desfecho em bombeiros de Belo Horizonte, Brasil. Estudo transversal foi realizado em 2011. Dentre 794 elegiveis, 711 (89,5%) participaram. Informacoes foram obtidas por questionario de autorrelato: variaveis sociodemograficas e ocupacionais, saude e eventos extralaborais adversos. A prevalencia de TEPT foi 6,9%. Variaveis ocupacionais contribuiram para explicar o desfecho no modelo final (regressao logistica multivariavel): fatores psicosssociais do trabalho, eventos traumaticos ocupacionais, tempo de trabalho e absenteismo. Idade, problemas de saude mental no passado e eventos adversos extralaborais tambem foram associados ao TEPT. Os resultados sao discutidos considerando os pressupostos do Modelo Demanda-Controle.

Back pain in adults living in quilombola territories of Bahia, Northeastern Brazil

OBJECTIVE To analyze the factors associated with back pain in adults who live in quilombola territories. METHODS A population-based survey was performed on quilombola communities of Vitória da Conquista, state of Bahia, Northeastern Brazil. The sample (n = 750) was established via a raffle of residences. Semi-structured interviews were conducted to investigate sociodemographics and employment characteristics, lifestyle, and health conditions. The outcome was analyzed as a dichotomous variable (Poisson regression). RESULTS The prevalence of back pain was of 39.3%. Age ≥ 30 years and being a smoker were associated with the outcome. The employment status was not related to back pain. CONCLUSIONS The survey identified a high prevalence of back pain in adults. It is suggested to support the restructuring of the local public service in order to outline programs and access to healthy practices, assistance, diagnosis, and treatment of spine problems.

P337 Occupational stressors and job satisfaction among firefighters from belo horizonte city, brazil

This study aimed to investigate the association between occupational stressors and job satisfaction among firefighters from a unit from Belo Horizonte City, Brazil. The cross-sectional study was conducted in 2014. Among 138 elegible, 115 (83.3%) firefighters participated in this survey. The mean age was 36.57 (SD = 8) years old and the majority were male (83.3%) and married (64.50%). Regarding schooling, 57.9% had completed high school. The mean service time in the institution was 13.76 (SD = 8.69) years. The instruments used were Job Content Questionnaire and Job Satisfaction Scale. Both instruments have been validated for the Brazilian population. All participants read and signed the informed consent term. For data analysis, descriptive statistics were used to characterise the participants and the mean scores in the dimensions of the constructs assessed by questionnaires. ANOVA was used to compare the work satisfaction among demand-control groups. The level of significance in the analysis was 0.05. In relation to overall job satisfaction, the results showed mild score levels. The highest satisfaction rates were observed in the active work group (high demand and high control). The lowest rates were reported by passive work group (low demand and low control). The results support the hypothesis that occupational stressors are associated with job satisfaction levels among firefighters. The results are discussed considering the assumptions of Demand-Control Model.