José Roberto Goldim

Clinical profile, quality of life and depressive symptoms of women with urinary incontince attending a university hospital

OBJECTIVESnTo describe the characteristics of urinary incontinence (UI) and to evaluate its impact on health-related quality of life (QOL) and depressive symptoms in women referred for physical therapy at a university hospital.nnnMETHODSnA descriptive cross-sectional study with demographic data collection related to UI. All women were evaluated through examination and also through depression and QOL questionnaires.nnnRESULTSnForty-eight women were evaluated (53.8±10.9 years), 47.9% with mixed UI (MUI), 39.6% with stress UI (SUI) and 12.5% with urge UI (UUI). In 50% of the cases the urinary loss lasted between 3.3 and 10 years. There was no significant difference in the pelvic floor muscle strength among the different types of UI (P>0.05). Depressive symptoms were detected in 37% of the women. Changes in the QOL were observed in all three groups of women with UI. According to the Kings Health Questionnaire (KHQ), women with MUI presented more compromised health perception and greater physical, social, daily activity and personal relationship limitations (P<0.05). The women with MUI presented a worse health perception (P<0.05) according to the WHOQOL-Bref.nnnCONCLUSIONnDepressive symptoms were detected in more than a third of the women whose quality of life was adversely affected and the greatest impact was observed in the patients with MUI.

The effect of outpatient physical therapy intervention on pelvic floor muscles in women with urinary incontinence

OBJECTIVEnTo assess the effect of a weekly, short-term physical therapy intervention on the pelvic floor muscles and urinary incontinence (UI) among patients of the public health system.nnnMETHODnQuasi-experimental before-and-after study. Clinical history and function evaluation were performed using perineal bidigital maneuvers and perineometry. The intervention consisted of transvaginal electrical stimulation and pelvic floor kinesiotherapy. Data were analyzed using the paired t test or Wilcoxon signed-rank test, Pearson product-moment correlation coefficient or Spearmans rank correlation coefficient. A value of P<0.05 was considered significant.nnnRESULTSnEight-two women 55.1±10.9 years-old were evaluated. Mixed urinary incontinence (MUI), stress urinary incontinence (SUI) and urge urinary incontinence (UUI) were observed in 52.4%, 36.6% and 11%, respectively. The length of UI was 6.0 years (3.0-10). Approximately 13.64 physical therapy sessions were held on average. There was no difference in perineometry measurements following the intervention (40.6±24.1 versus 41.7±25.4, P=0.098). Muscle function significantly increased (P<0.01) in the bidigital maneuver. The patients reported being continent or satisfied with the treatment in 88.9% of cases.nnnCONCLUSIONSnThe results demonstrated an increase in muscle function and the attainment of urinary continence or treatment satisfaction in most cases.

Avaliação da qualidade de vida e tomada de decisão em idosos participantes de grupos socioterápicos da cidade de Arroio do Meio, RS, Brasil

The aim of the study was to evaluate the domains of quality of life (WHOQOL-OLD Questionnaire) and the ability of decision-making (Questionnaire for Evaluation of the Moral and Psychological Development) of elderly who took part of the socio-therapeutic groups of Arroio do Meio city, Rio Grande do Sul state, Brazil. The research was described as transversal, observative, descriptive, developed among individuals participating in elderly groups. From the sample formed by 133 elderly, Intimacy obtained the most expressive average (69.12 + 23.52). Autonomy obtained the lowest average (38.68 + 16.76) and the average of The psycho-moral development was 4.4, placed in the phase of Awareness. The elderly from Arroio do Meio are satisfied with the ability of establishing intimate and personal relationships and with social participation in the community. They have low global score on quality of life, but are totally able of taking their own decisions.

Genetics and ethics: a possible and necessary dialogue

Genetics and ethics have had numerous convergences and divergences over time. From Darwin through the Asilomar Conference and the Universal Declaration on the Human Genome and Human Rights, much has been achieved, but much still remains to be done. The use of biological materials that are already being stored and the adequacy of new technologies, such as clustered regularly interspaced short palindromic repeats (CRISPR), are some of the current challenges of this possible and necessary interaction. This paper will discuss some ethical aspects involved in current genetics.

Ethics, genetics and pediatrics

OBJECTIVESnTo reflect on the nature of ethics, from a contemporary perspective, and also on which features of the family relationship have an impact on the interface between genetics and pediatrics.nnnSOURCESnThe data used are the fruit of the authors own intellectual production plus other bibliographic references.nnnSUMMARY OF THE FINDINGSnGenetics has presented ethics with new challenges. Particularly in pediatrics, where caring for patients is almost indivisible from a continuous relationship with their families, these issues are amplified even further, generating new questions that health professionals have not previously had to face.nnnCONCLUSIONSnBased on the reflections outlined here, emphasis can be placed on the importance of actively recognizing the Other in its multiple dimensions and on the repercussions that this perspective has for the physician-patient-family relationship.

Futilidade terapêutica e insuficiência respiratória: realização de um estudo de coorte prospectiva

BACKGROUND AND OBJECTIVES: Currently, the reformulation of intensive care goals, often shifting from the search for a cure to offering comfort, has become more and more necessary. The intensivist is frequently confronted with the decision to suspend or not offer a specific therapy, despite its availability. The objective of this study was to estimate the developing risk of probability of death for individual ICU patients with respiratory failure, identify which life-sustaining therapies were administered, time of internment and outcome. Compare the death outcome in relation to UNICAMP II and APACHE II models, as well as verify if the life-sustaining therapies may be limited or suspended. METHODS: It is the observational, prospective cohort study of 150 patients with respiratory failure confined to the intensive care unit. Statistical analysis was carried out using Generalized Linear Models. RESULTS: Age, sex, race or morbidity did not reveal statistical significance in predicting outcome. This prediction was confirmed more accurately by means of changes in the individual prognostic index of death probability during the first seven days of ICU internment. A 10% worsening prognosis in patients who presented initial death risk of 70% to 80%, utilizing the UNICAMP II Model, showed a specificity of 97.4% - 98.6%. CONCLUSIONS: Prognostic changes in patients during the first seven days of ICU internment are of great aid, from an objective point of view, for ethical decision-making in relation to not-offering new life-sustaining therapies.

Telecare for the elderly: coercion, confidence and satisfaction associated with its use

Objective: to evaluate the expression of coercion, confidence and satisfaction with the use of telecare. Method: a cross-sectional study was carried out of prevalent cases with elderly residents in the city of Porto Alegre, Rio Grande do Sul, Brazil, who had already used telecare services. The sociodemographic variables used were: gender, age, schooling and Palavras-chave: Saúde do Idoso. Tecnologia Assistiva. Coerção. http://dx.doi.org/10.1590/1981-22562018021.170200

Health professionals' perceptions about the decision-making process in the care of pediatric patients

Objective To evaluate the perceptions of physicians, nurses and nursing technicians of their participation in the decision-making process surrounding life support limitation in terminally ill pediatric patients, with comparisons by professional category. Methods A cross-sectional study was conducted in the pediatric intensive care unit of a tertiary public university hospital with the participation of physicians, nurses and nursing technicians. The MacArthur Admission Experience Survey Voice Scale was used to assess and quantify the perceptions of professionals who assisted 17 pediatric patients with life support limitation within 24 hours after the outcome of each patient was determined. All professionals working in the unit (n = 117) who were potentially eligible for the study received a free and informed consent form prior to the occurrence of the cases studied. Results Study participants included 25/40 (62.5%) physicians, 10/17 (58.8%) nurses and 41/60 (68.3%) nursing technicians, representing 65% of the eligible professionals identified. The questionnaire return rate was higher for physicians than technicians (p = 0.0258). A perceived lack of voice was reported in all three professional categories at varying rates that were lower for physicians than for nurses and nursing technicians (p < 0.00001); there was no difference between the latter (p = 0.7016). In the three professional categories studied, three subscale items were reported. For two of the three statements, there were significant differences between physicians and nurses (p = 0.004) and between physicians and nursing technicians (p = 0.001). For one of the statements, there was no difference among the three professional categories. Conclusion Respondents perceived a lack of voice in the decision-making process at varying rates across the three categories of studied professionals who assisted terminally ill pediatric patients with life support limitation, with physicians expressing lowered rates of perceived coercion.

Perceived coercion of noninstitutionalized elderly patients undergoing research for the diagnosis of temporomandibular joint dysfunction

Objetivo: Neste estudo, avaliou-se a percepcao de coercao (PC) em idosos nao institucionalizados submetidos a pesquisa para diagnosticoxa0da Disfuncao Temporomandibular. Metodo: Realizou-se estudo transversal com 1.112 idosos, com idade igual ou superior a 60 anos, inscritos no Programa da Saudexa0da Familia do municipio de Areia, Estado da Paraiba, Brasil, no periodo de janeiro a junho de 2013. Utilizou-se como instrumento dexa0coleta a Escala de Percepcao de Coercao. Resultados: Houve predominância de pessoas do sexo feminino (62,5%), com faixa etaria de 60 a 69 anos (45,9%) nao alfabetizadosxa0(57,9%), casados ou em uniao estavel (54,1%), aposentados (83,6%) e com renda mensal inferior a um salario minimo (72,0%).xa0A media geral de PC foi de 1,25+ 1,15 e Moda 1 (41,4%). Houve diferenca da PC entre o grupo de alfabetizados, casados e em uniaoxa0estavel versus os demais. Conclusao: Percebeu-se o grupo de idosos pouco coagido ao decidir quanto a sua participacao na pesquisa para diagnostico daxa0Disfuncao Temporomandibular, com associacao signifi cativa da PC com alfabetizacao e estado civil.OBJECTIVEnTo evaluate perceived coercion (PC) of noninstitutionalized elderly patients undergoing research for the diagnosis of temporomandibular joint dysfunction.nnnMETHODnA cross-sectional study conducted with 1,112 elderly individuals aged 60 or older, enrolled in the Family Health Programme of the municipality of Areia, State of Paraíba, Brazil, from January to June 2013. The data collection tool was the Perceived Coercion Scale (PSC).nnnRESULTSnThe participants were predominantly women (62.5%) in the 60 to 69 age group (45.9%), illiterate (57.9% percent), married or in a common law marriage (54.1%), retired (83.6%), and receiving a monthly income under the minimum wage (72.0%). The average overall PC was 1.25+ 1.15 and Trend 1 (41,4%). There was a difference between the group of individuals who were literate, married and in a common law marriage and the members of the other groups.nnnCONCLUSIONnResults showed that the elderly patients were minimally coerced when deciding whether to participate in research for diagnosing temporomandibular joint dysfunction. They also revealed a significant association of PC with literacy and marital status.

Avaliação da percepção de coerção em idosos não institucionalizados submetidos a pesquisa para diagnóstico da disfunção temporomandibular

Objetivo: Neste estudo, avaliou-se a percepcao de coercao (PC) em idosos nao institucionalizados submetidos a pesquisa para diagnosticoxa0da Disfuncao Temporomandibular. Metodo: Realizou-se estudo transversal com 1.112 idosos, com idade igual ou superior a 60 anos, inscritos no Programa da Saudexa0da Familia do municipio de Areia, Estado da Paraiba, Brasil, no periodo de janeiro a junho de 2013. Utilizou-se como instrumento dexa0coleta a Escala de Percepcao de Coercao. Resultados: Houve predominância de pessoas do sexo feminino (62,5%), com faixa etaria de 60 a 69 anos (45,9%) nao alfabetizadosxa0(57,9%), casados ou em uniao estavel (54,1%), aposentados (83,6%) e com renda mensal inferior a um salario minimo (72,0%).xa0A media geral de PC foi de 1,25+ 1,15 e Moda 1 (41,4%). Houve diferenca da PC entre o grupo de alfabetizados, casados e em uniaoxa0estavel versus os demais. Conclusao: Percebeu-se o grupo de idosos pouco coagido ao decidir quanto a sua participacao na pesquisa para diagnostico daxa0Disfuncao Temporomandibular, com associacao signifi cativa da PC com alfabetizacao e estado civil.OBJECTIVEnTo evaluate perceived coercion (PC) of noninstitutionalized elderly patients undergoing research for the diagnosis of temporomandibular joint dysfunction.nnnMETHODnA cross-sectional study conducted with 1,112 elderly individuals aged 60 or older, enrolled in the Family Health Programme of the municipality of Areia, State of Paraíba, Brazil, from January to June 2013. The data collection tool was the Perceived Coercion Scale (PSC).nnnRESULTSnThe participants were predominantly women (62.5%) in the 60 to 69 age group (45.9%), illiterate (57.9% percent), married or in a common law marriage (54.1%), retired (83.6%), and receiving a monthly income under the minimum wage (72.0%). The average overall PC was 1.25+ 1.15 and Trend 1 (41,4%). There was a difference between the group of individuals who were literate, married and in a common law marriage and the members of the other groups.nnnCONCLUSIONnResults showed that the elderly patients were minimally coerced when deciding whether to participate in research for diagnosing temporomandibular joint dysfunction. They also revealed a significant association of PC with literacy and marital status.