Juliana Molina

Confiabilidade do módulo Satisfação com o Serviço de Saúde do questionário Pediatric Quality of Life Inventory versão 3.0 na avaliação do atendimento de crianças e adolescentes com doenças crônicas

Objective: To translate to Brazilian Portuguese and to evaluate the reliability of the Healthcare Satisfaction (HS) Generic Module version 3.0 of the PedsQL inventory for the Brazilian culture. Method: The methods recommended by the authors of the original version of the questionnaire were used: 1) translation by bilingual experts; 2) back translation into English and evaluation by the authors of the original version; 3) a pilot study including 10 parents (cognitive interview); and 4) evaluation of the measurement properties of the questionnaire. The questionnaire was administered to 60 parents of children and adolescents with chronic diseases in key units of the Department of Pediatrics. Results: Cronbach’s alpha ranged from 0.57 to 0.78 for all domains (information, family inclusion, communication, technical skills, emotional needs and overall satisfaction), which confirmed good internal consistency. Test-retest reproducibility was evaluated using 20% of the sample (Spearman correlation coefficient = 0.909). The satisfaction score was good in all areas (> 4.3 points) except in the emotional needs domain. Conclusion: The Brazilian version of the HS-PedsQL is a valid and reliable tool to measure the overall satisfaction of parents and caregivers with the treatment of their children.OBJECTIVE To translate to Brazilian Portuguese and to evaluate the reliability of the Healthcare Satisfaction (HS) Generic Module version 3.0 of the PedsQL inventory for the Brazilian culture. METHOD The methods recommended by the authors of the original version of the questionnaire were used: 1) translation by bilingual experts; 2) back translation into English and evaluation by the authors of the original version; 3) a pilot study including 10 parents (cognitive interview); and 4) evaluation of the measurement properties of the questionnaire. The questionnaire was administered to 60 parents of children and adolescents with chronic diseases in key units of the Department of Pediatrics. RESULTS Cronbachs alpha ranged from 0.57 to 0.78 for all domains (information, family inclusion, communication, technical skills, emotional needs and overall satisfaction), which confirmed good internal consistency. Test-retest reproducibility was evaluated using 20% of the sample (Spearman correlation coefficient = 0.909). The satisfaction score was good in all areas (> 4.3 points) except in the emotional needs domain. CONCLUSION The Brazilian version of the HS-PedsQL is a valid and reliable tool to measure the overall satisfaction of parents and caregivers with the treatment of their children.

Sleep, stress, neurocognitive profile and healthrelated quality of life in adolescents with idiopathic musculoskeletal pain

OBJECTIVES: The aims of this study were to measure levels of sleep, stress, and depression, as well as health-related quality of life, and to assess the neurocognitive profiles in a sample of adolescents with idiopathic musculoskeletal pain. METHODS: Nineteen adolescents with idiopathic musculoskeletal pain and 20 age-matched healthy control subjects were evaluated regarding their levels of sleep and stress, as well as quality of life, and underwent neurocognitive testing. RESULTS: The sample groups consisted predominantly of females (84%), and the socioeconomic status did not differ between the two groups. In addition, the occurrence of depressive symptoms was similar between the two groups; specifically, 26% of the idiopathic musculoskeletal pain patients and 30% of the control subjects had scores indicative of depression. Teenagers in the group with idiopathic musculoskeletal pain reported poorer quality of life and sleep scores than those in the control group. Regarding stress, patients had worse scores than the control group; whereas 79% of the adolescents with idiopathic musculoskeletal pain met the criteria for a diagnosis of stress, only 35% of the adolescents in the control group met the criteria. In both groups, we observed scores that classified adolescents as being in the resistance phase (intermediate) and exhaustion phase (pathological) of distress. However, the idiopathic musculoskeletal pain group more frequently reported symptomatic complaints of physical and emotional distress. The neurocognitive assessment showed no significant impairments in either group. CONCLUSION: Adolescents with idiopathic musculoskeletal pain did not exhibit cognitive impairments. However, adolescents with idiopathic musculoskeletal pain did experience intermediate to advanced psychological distress and lower health-related quality of life, which may increase their risk of cognitive dysfunction in the future.

Dor musculoesquelética idiopática difusa na infância e na adolescência

Objective: Persistent or intermittent diffuse idiopathic musculoskeletal pain is defined by the presence of pain over three months with no apparent etiology. The diagnosis of this condition in children and adolescents is increasing. The objective of this study was to report the cases of two patients with disabling pain that received multidisciplinary treatment and to review the current literature about this subject. Case description: The first patient is a nine-year old girl with history of headache, musculoskeletal pain and abdominal pain for two years. During this period she had four episodes of absence of gait with no apparent organic cause. The second patient is a 14-year girl with severe daily low back pain for 14 months, followed by headache and fatigue. Both patients presented a normal physical examination, except for allodynia (case 1) and fibromyalgia tender points (case 2). All tests resulted negative regarding the search for organic reasons for pain complaints. Significant clinical improvement was observed with a multidisciplinary approach offered by pediatricians, psychologists, physical therapists, and nutritionists. Both patients resumed their daily regular activities. Comments: Team integrated performance in a short-term period can provide the attenuation of pain symptoms since emotional, physical and nutritional factors are related to the pain expressed by the patients.

Classification of the International Affective Picture System (IAPS) images for teenagers of the city of São Paulo.

Normative studies of the International Affective Picture System (IAPS) have been developed in several countries, observing culturally determined differences, which seem to vary by age group and gender. Brazil has normative data for the seniors and adults; however, pediatric studies are scarce. The objective of the study was to obtain the category ratings for valence and arousal of a set of these images for Brazilian teenagers and check whether its ratings are gender related. In the study, 161 teenagers, aged 12–18 years, categorized valence and arousal dimensions of 180 pictures from the IAPS through the Self-Assessment Manikin instrument. The comparison between genders showed differences in this classification. Teenage girls attributed more valence and less arousal to pleasant images and less valence and more arousal when facing unpleasant figures compared with teenage boys. In addition, both genders expressed their emotions in different intensities but were similar in categorizing this emotionality (as pleasant, unpleasant, or neutral). The IAPS proved to be an effective tool for assessing emotional reactions because the general categorization followed an equivalent pattern observed in previous studies and validated a set of IAPS images for use properly in Brazilian teenagers.

Psychological characteristics of caregivers of pediatric patients with chronic rheumatic disease in relation to treatment adherence

BackgroundAdherence to treatment for chronic diseases is lower in children than in adults, less extensively studied in children and is associated with multiple related factors. The aim of this study is to perform a descriptive analysis of psycho-cognitive aspects of primary caregivers of pediatric patients with chronic rheumatic diseases, as well as socioeconomic and clinical factors, family functioning and treatment satisfaction.MethodsPrimary caregivers of 90 patients were included. Pairs (caregiver plus patient) were grouped as presenting good adherence (n = 50) or poor adherence (n = 40) according to the Morisky Adherence Test. Psycho-cognitive aspects were evaluated by Adult Self-Report and Wechsler Adult Intelligence Scale tests. For statistical comparisons, quantitative variables with normal distribution were analyzed by Student’s t test, and those with non-Gaussian distribution with the Mann Whitney test. Categorical variables were analyzed by Chi square test. A multivariate logistic regression analysis was performed to estimate the contribution of the independent variables to adherence.ResultsCompared to caregivers in the good adherence group, caregivers in the poor adherence group were more likely to be classified as clinical on the scales for attention problems and externalizing problems, which include impulsiveness and aggressiveness. They also scored higher on the depressive problem scale. In addition, the average number of children per caregiver and the mean age of caregivers and patients were significantly higher in the poor adherence group, while the proportion of caregivers with higher education was lower. The poor adherence group also included a higher incidence of pediatric patients assuming sole responsibility for managing medications. Economic status, clinical factors, treatment satisfaction, family functioning and caregiver cognitive profile were not related to adherence, except for working memory index.ConclusionOlder patients, patients as the one solely responsible for medication management, and caregivers with externalizing problems, were observed to be the most strongly associated to poor adherence. Interventions aimed at adolescent patients are needed. Also, psychological programs and interventional studies to better determine caregivers’ behavioral/emotional status, and parent-child relationships are recommended.

Influence of the cognitive aspects of caregivers in the adhesion of treatment in children and adolescents with chronic rheumatic diseases-preliminary data

The adhesion to treatment is a key factor for an effective treatment. Studies have showed considerable taxes in poor adhesion in children and adolescents with rheumatic diseases, which lead to long-term costs and consequences for the patient, the family, and society. Psychological conditions and familial support have demonstrated to be a strong influence in the adhesion to treatment.

Pain threshold in adolescents with juvenile idiopathic arthritis and fibromyalgia

Pain is a frequent complaint in pediatric practice and is present in several chronic organic diseases, such as juvenile idiopathic arthritis (JIA). While JIA patients show symptoms such as inflammation of the joints and other structures, such as the heart and eyes, patients with idiopathic musculoskeletal pain (IMP) experience a painful condition that is not associated with presence of tissue injuries. Juvenile fibromyalgia (JFM), disorder characterized by recurrence of disabling pain, is a classic example IMP. This study shows preliminary data of a protocol for evaluation of brain activation using functional magnetic resonance imaging (fMRI) after a painful stimulus produced by pressure.

Psychosocial profile of children and adolescents followed in a pediatric musculoskeletal pain clinic

Amplified pain syndrome preferentially affects girls between the ages of 10-17 years. It is a disease with multiple causes that could be associated with major psychosocial disorders of patients and caregivers, affecting their quality of life. These psychosocial aspects can interfere intensifying the pain.