Eliane Maria Fleury Seidl

Qualidade de vida e saúde: aspectos conceituais e metodológicos

The quality of life (QL) concept has led to extensive scientific research and has been increasingly used by health care professionals treating a wide range of diseases. This paper addresses the historical use of the concept and specific issues linked to conceptual and methodological aspects of the QL construct within the health care context. Reviewing the literature, two aspects stand out: subjectivity and multidimensionality. In the methodological field, the construction and/or adaptation of QL measurement instruments appear as a significant trend. Theoretical and methodological efforts have helped clarify and improve the concepts adequacy. The QL construct is definitely interdisciplinary, encompassing contributions by different areas of knowledge and research, thereby improving its conceptual and methodological potential as a research instrument. Therefore, use of the concept can actually help improve both the quality and the integrated, multidimensional nature of health care from a perspective that views the latter as a basic citizens right.

Análise Fatorial de Uma Medida de Estratégias de Enfrentamento

The goal of this study was to investigate the factorial structure of the Brazilian version of the Ways of Coping Scale (Gimenes & Queiroz, 1997) that measures coping strategies people use when facing specific stressors. The sample of 409 male and female adults was divided into two groups: 252 reported one major stressor related to a real problem in their everyday activities and the other 157 reported and described the suffering of a chronic disease. A factor analysis with principal axis method and orthogonal rotation, extracted four factors: coping strategies based on the stressor, coping strategies based on the emotion, religiosity/fantasy thinking and search for social support. Comparisons between the two samples suggested different possibilities for the development of research and intervention in the clinical work aimed at the management of stress by different type of patients.

Pessoas vivendo com HIV/AIDS: enfrentamento, suporte social e qualidade de vida

A model describing quality of life (QoL) as a function of health conditions, education, marital status, coping and social support in symptomatic or asymptomatic HIV-infected patients was tested. The participants were 241 adults, aged 20 to 64, 161 men, 169 symptomatic, and 208 on antiretroviral treatment. The criterion variable QoL was represented by the psychosocial, physical, environmental and overall quality of life dimensions measured by the Brazilian version of the World Health Organization QoL Assessment. Hierarchical multiple regression analysis revealed that the emotional support, emotion-focused coping, problem-focused coping, and marital status were significant predictors explaining 59% (adjusted) of the variance in the psychosocial dimension. Emotional support and emotion-focused coping were significant predictors associated to the other QoL analyzed dimensions. Implications concerning professional interventions and factors that should contribute to the improvement of the psychological well-being and QoL of seropositive persons are discussed.

Religiosidade e enfrentamento em contextos de saúde e doença: revisão da literatura

There are frequent allusions to the influence of religious aspects on cure and ilness processes in health contexts. In the last two decades, the relationship between religiosity and coping has been investigated mostly by social sciences and health researchers. This article consists on a literature review about religiosity and coping in health contexts. Cognitive or behavioral strategies which come from religiosity in order to cope with stress are called religious coping. This review includes historic aspects of the connection between religiosity and health, the positive and negative functions of religious coping, the religious coping assessment by instruments, and some research results in this area.

Pessoas vivendo com HIV/AIDS: variáveis associadas à adesão ao tratamento anti-retroviral

This study aimed to describe the adherence of persons living with HIV/AIDS to antiretroviral therapy (ART) and to investigate adherence predictors among the following: level of schooling, presence of side effects, current or previous interruption of ART by the persons themselves, self-esteem, self-efficacy expectation, coping strategies, social support, and satisfaction with the health professional-patient relationship. Adherence was measured by self-reported number of ART pills/capsules missed during the previous week and previous month, evaluated as satisfactory when less than 5%. 101 HIV+ adults took part in this study, 60.4% males, ranging from 20 to 71 years of age (mean = 37.9 years), and 73.3% symptomatic. Data procedures included interviews and the use of validated instruments. The majority of participants (n = 73; 72.3%) reported adherence of > 95%. Logistic regression showed that a history of self-reported ART interruption and self-efficacy expectations were significant adherence predictors. Upgrading of care with interdisciplinary teams is needed to develop an appropriate approach to the medical and psychosocial difficulties of ART adherence by persons with HIV/AIDS.

Desenvolvimento de escala para avaliação do suporte social em HIV/aids

This study investigated the factorial structure and the psychometric properties of The Social Support Scale for People with HIV/Aids based on items from a canadian scale for evaluation of the social support for people living with HIV/aids, on initiatives of brazilian researchers and on the revision of the literature about the social support construct. The validation sample was composed of 241 HIV positive individuals (66.8% males), with ages between 20 and 64 years old (M =37.4 years). The exploratory factorial analysis using the principal axis extraction method and oblique rotation revealed two first order factors: emotional social support (12 items, a=0.92) and instrumental social support (12 items, a=0.84). A second order factor was also identified with all 24 original items, with good psychometric indicators (a=0.87). The factorial structure found corresponded to what is expected from an instrument aimed at measuring the major social support dimensions of people who are HIV positive.

Crianças e adolescentes vivendo com HIV/Aids e suas famílias: aspectos psicossociais e enfrentamento

The objectives of this study were to describe socio-demographic and medical aspects of children and adolescents who acquired HIV infection during the prenatal period. It also intends to describe de organizational aspects of their families; to delineate difficulties and stressors perceived by caregivers based upon psychosocial and HIV-related issues, so that it became able to analyze coping strategies utilized, one of the main objectives of this paper. Forty-three primary caregivers took part in this research, most of them were mothers infected with HIV (24), between the ages of 18 and 68. The instruments used included a semi-structured interview and the Ways of Coping with Problems Scale (WCPS). The results revealed difficulties in areas such as adherence to treatment, disclosure of diagnosis to children/adolescents and providing of information about the diagnosis at school. With reference to the coping strategies, there was a predominance of search for religious practices/fantastical thoughts and problem focusing, according to the scores of the WCPS. The study corroborates the necessity for health care professionals to strive to sharpen their professional expertise to attend psychosocial demands, endeavoring to devote interdisciplinary attention to children and adolescents living with HIV/AIDS, as well as their family members.

Religiosidade, enfrentamento e bem-estar subjetivo em pessoas vivendo com HIV/AIDS

The main objective of this study was to investigate some modalities of coping, including the religious coping (RC), educational level and health condition (symptomatic or asymptomatic to aids) that predict positive and negative affect in sample consisted of 110 HIV positive patients, 68,2% males, between 21 and 60 years old. Proceedings included the assisted application of sociodemografic, medical-clinical and religious beliefs and practices questionnaires, the Positive and Negative Affect Scale, the Ways of Coping Scale and the Brazilian version of the BriefRCOPE. Multiple regression analysis indicated that the emotion-focused coping was the strongest (negative) predictor, followed by problem-focused coping (8%) and positive RC (2%) which explained a total of 30% (adjusted) of variance of positive affect. As to negative affect, the emotion-focused coping and problem-focused coping (negative) making 36% (adjusted) of the explained variance. These results may be used for interventions with patients and their families concerning the possible effects of coping and positive and negative RC in the illness-health process.

Monitoramento e avaliação da adesão ao tratamento antirretroviral para HIV/aids: desafios e possibilidades

The advances in research and treatment regimens have transformed aids into a chronic illness, with a marked increase in the quality of life of those living with HIV/aids. This brings new challenges in understanding and treating the disease and those living with it. From this perspective, adherence to antiretroviral treatment (ART) has been made a priority in the public policy of countries such as Brazil. This article discusses the challenges and potential solutions to the monitoring and evaluation of adherence to ART as well as the advantages and disadvantages of the techniques available for its assessment. Emphasis was given to the work done in countries with scarce resource with patients who have little or no formal education. It is necessary to take into account logistic, conceptual and empirical aspects in the choice of methods to monitor the adherence, examining sociocultural and economic contexts, especially in countries with scarce resource. The conclusion is that identify adequate and effective ways of measuring adherence remains an important challenge for those who work with HIV/aids.

Enfrentamento, aspectos clínicos e sociodemográficos de pessoas vivendo com HIV/Aids

The study aimed at describing coping strategies of people living with HIV/AIDS and identifying associations between modalities of coping and sociodemographic variables s uch as s ex, schooling and marital status, as well as clinical ones (symptomatic versus asymptomatic c onditions). A convenience sample was composed with 241 HIV+ people, 161 (66,8%) were men b etween the a ges of 20 and 64 (M=37,4), 169 (70,1%) symptomatic. The instruments used included structured qu estionnaires and a Brazilian version o f a scale for measure strategies of coping, with assisted application and fulfilling of scale without t he presence of researchers. Results s howed variability in the c oping strategies used, with predomination of problem-focused coping. Amongst women and less educated individuals there was a prevalence of emotion- focused coping and search for religious practices. The results provide subsidy for HIV-positive patients to draw sustenance from psychological support. Limitations of conceptualization and evaluation of coping are discussed and must be taken into consideration for future reference in further research.