Liliane Lins

SF-36 total score as a single measure of health-related quality of life: Scoping review

According to the 36-Item Short Form Health Survey questionnaire developers, a global measure of health-related quality of life such as the “SF-36 Total/Global/Overall Score” cannot be generated from the questionnaire. However, studies keep on reporting such measure. This study aimed to evaluate the frequency and to describe some characteristics of articles reporting the SF-36 Total/Global/Overall Score in the scientific literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was adapted to a scoping review. We performed searches in PubMed, Web of Science, SCOPUS, BVS, and Cochrane Library databases for articles using such scores. We found 172 articles published between 1997 and 2015; 110 (64.0%) of them were published from 2010 onwards; 30.0% appeared in journals with Impact Factor 3.00 or greater. Overall, 129 (75.0%) out of the 172 studies did not specify the method for calculating the “SF-36 Total Score”; 13 studies did not specify their methods but referred to the SF-36 developers’ studies or others; and 30 articles used different strategies for calculating such score, the most frequent being arithmetic averaging of the eight SF-36 domains scores. We concluded that the “SF-36 Total/Global/Overall Score” has been increasingly reported in the scientific literature. Researchers should be aware of this procedure and of its possible impacts upon human health.

Health-related quality of life of students from a private medical school in Brazil

Objectives To assess health-related quality of life (HRQOL) and to describe factors associated with its variation among undergraduate medical students at a Brazilian private medical school. Methods A cross-sectional study in a sample (n=180) of medical students at a private medical school in Salvador, Brazil, stratified by year of medical course. Data about age, sex, year of course, physical activity, sleepiness, headaches, participation in a student loan program supported by the Brazilian government (FIES) and living arrangements were collected using a self-administered form. HRQOL was assessed by using a Brazilian Portuguese version of the SF-36 form. The eight domains of SF-36 and the Physical Component (PCS) and Mental Component (MCS) Summaries scales were calculated. Results The medical students showed poor HRQOL, mainly because of the mental component. Lower mean scores were found among those with FIES support, females, those suffering from sleepiness, headaches and lacking physical activity. No clear trend was observed in the variation of the SF-36 mean scores according to the year of medical school. However, students in the fifth year of the course had the highest HRQOL mean scores. Conclusions Health-related quality of life of students at this private medical school was poor, mainly because of its mental component. Lower HRQOL was associated with FIES support, females, sleepiness, headaches and lack of regular physical activity. Higher scores were found among fifth year students.

Oral health profile in patients infected with HTLV‐1: Clinical findings, proviral load, and molecular analysis from HTLV‐1 in saliva

Human T‐lymphotropic virus type 1 (HTLV‐1) is associated with adult T‐cell leukemia (ATL) and HTLV‐1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) and has also been implicated in several disorders, including periodontal disease. The proviral load is an important biological marker for understanding HTLV‐1 pathogenesis and elucidating whether or not the virus is related to the clinical manifestation of the disease. This study describes the oral health profile of HTLV‐1 carriers and HAM/TSP patients in order to investigate the association between the proviral load in saliva and the severity of the periodontal disease and to examine virus intra‐host variations from peripheral blood mononuclear cells and saliva cells. It is a cross‐sectional analytical study of 90 individuals carried out from November 2006 to May 2008. Of the patients, 60 were HTLV‐1 positive and 30 were negative. Individuals from the HTLV‐1 positive and negative groups had similar mean age and social‐economic status. Data were analyzed using two available statistical software packages, STATA 8.0 and SPSS 11.0 to conduct frequency analysis. Differences of P < 0.05 were considered statistically significant. HTLV‐1 patients had poorer oral health status when compared to seronegative individuals. A weak positive correlation between blood and saliva proviral loads was observed. The mean values of proviral load in blood and saliva in patients with HAM/TSP was greater than those in HTLV‐1 carriers. The HTLV‐1 molecular analysis from PBMC and saliva specimens suggests that HTLV‐1 in saliva is due to lymphocyte infiltration from peripheral blood. A direct relationship between the proviral load in saliva and oral manifestations was observed. J. Med. Virol. 84:1428–1436, 2012.

Scientific Integrity in Brazil

This article focuses on scientific integrity and the identification of predisposing factors to scientific misconduct in Brazil. Brazilian scientific production has increased in the last ten years, but the quality of the articles has decreased. Pressure on researchers and students for increasing scientific production may contribute to scientific misconduct. Cases of misconduct in science have been recently denounced in the country. Brazil has important institutions for controlling ethical and safety aspects of human research, but there is a lack of specific offices to investigate suspected cases of misconduct and policies to deal with scientific dishonesty.

Percepção de integridade científica para o estudante de medicina

This study aimed to investigate the medical students perception of scientific integrity, to discuss the need to address this topic throughout the education of ethically responsible researchers and to clarify the importance of educational practices that aim at ethically educating this student. This was a qualitative study, using the technique of thematic analysis. Data were collected through semi-structured interviews, by setting up three units of data analysis: the students knowledge about the CEP/Conep system (Research Ethics Committee/National Commission for Research Ethics system), the perception of students about scientific integrity and scientific dishonesty, and approach to the theme of scientific integrity in the medical curriculum. This study showed the need for a more effective approach on the CEP/Conep system. Similarly, the theme of scientific integrity seems to be little discussed in the academic environment which can lead to the practice of scientific misconduct due to lack of recognition of it by students. The combination of theory and practice in the teaching of scientific integrity is essential; this issue should be inserted early in the medical curriculum.

Increased expression of CD38 and HLADR in HIV-infected patients with oral lesion†

Persistent immune actiation is associated with innadequate immune recovery in HIV‐patients. This study assessed the relationship between frequency of expression of cell activation markers (CD38 and HLADR) and presence of oral lesions in HIV‐1 infected patients. Fifty‐seven HIV‐infected persons, undergoing antiretroviral treatment, were divided into three groups, according to the number of CD4+ T cells and CD4+/CD8+ ratio: adequate, partial, and inadequate immune restauration. All patients underwent full mouth assessments for saliva flow measurement, oral mucosal lesion, periodontal disease, and severity of periodontitis. Immune activation markers levels were compared according to three groups of periodontal disease (“No periodontal disease,” “gingivitis,” and “periodontitis”). Oral mucosal lesions (P = 0.03) and peridodontal disease (P = 0.03) were associated with lower CD4+/CD8+ ratio. Patients with oral mucosal lesions had significantly higher median levels of HLADR and CD38 markers in all T‐lymphocytes populations than patients without oral lesions. Patients with gingivitis and with periodontitis presented significantly higher median levels of CD3+ HLADR+, CD4+ HLADR+, CD8+ HLADR+, and CD3+ CD38+ and significantly lower CD4+/CD8+ ratio than patients with no periodontal disease. Increased levels of HLADR and CD38 expressions in peripheral blood were associated with oral lesions in HIV‐positive patients. Periodontal disease was associated with HLADR expression.

Código de ética do estudante de medicina: uma análise qualitativa

Code of ethics of medical student: a qualitative analysis This study aimed to compare the Brazilian Codes of Ethics for Medical Student. This was a qualitative study using the Medical Code of Ethics and The Brasilia, Federal District Code of Ethics for Medical Student as theoretical framework for analyzing the content from other Codes. Four Brazilian codes were identified: The Code of Ethics for Medical Student from Brasilia, Federal District; the Code of Ethics for Medicine students from Federal University of Bahia; the Code of Ethics for Medical Student from University of South of Santa Catarina and the Code of Ethics for Medical Students from the Regional Council of Medicine of Sao Paulo. It was concluded that all Codes of Ethics for medical student are similar and based on the Code of Medical Ethics. The elaboration of a unified Code was suggested to the Federal Council of Medicine in order to contribute to medical education in Brazil.

Perception of illegal practice of medicine by Brazilian medical students

Introduction Illegal practice of medicine by medical students is a worldwide problem. In Brazil, information about this issue is scarce. Objective To describe the perception of illegal practice of medicine by medical students. Methods A cross-sectional study in a stratified random sample of 130 medical students in the 6th to 12th semesters from a private faculty of medicine in Salvador, State of Bahia, Brazil, from September to October 2011. Students responded to a standardised questionnaire about the illegal practice of medicine by medical students. Results Knowing medical students who practised medical activities without supervision was reported by 86% of the respondents, and 93.8% had heard about someone who performed such practices. Medical specialties most often associated with illegal practice were general medicine (78.8%) and occupational health (55.9%). Illegal practice of medicine was more common in peripheral cities/towns (83.9%) than in the State capital, Salvador City (52.4%). Only 10.5% of illegal activities were reported to the authorities. Unsupervised medical practice was more often reported in the 8th–9th semester (56.8%) and 10th–11th semester (54.4%) of medical school. Conclusions Illegal practice of medicine was commonly reported by the medical students questioned. The high frequency of reported illegal practice for financial reasons highlights the need for greater availability of paid internships for medical students. Educational institutions represent the social control responsible for supervising the activities of academics.

Health-Related Quality of Life of Former Lead Workers in Brazil

Little is known about the health-related quality of life of former lead workers. Using the Short-Form 36 Questionnaire (SF-36), a cross-section design study evaluated the health-related quality of life of 186 former workers of a lead smelter that operated in Santo Amaro da Purificação, Brazil, from 1960 to 1993, when it closed down. The smelter had very poor occupational and environmental hygiene standards. The health-related quality of life of former lead workers was low, compared to population-based and other nosological groups from Brazil. Former lead workers who indicated metal poisoning, difficulty getting another job and who could not get another job after dismissal by the smelter presented poorer health-related quality of life. Former lead workers with poor health-related quality of life form part of the huge occupational liability left by the Santo Amaro lead smelter.

Association Between Health-Related Quality of Life and Physical Functioning in Antiretroviral-Naive HIV-Infected Patients

Background: Poor functional status can significantly affect Health-Related Quality of Life (HRQoL) of HIV patients. However, there is scarce information on the functional profile of such patients before starting antiretroviral therapy (ART). Objective: To estimate the association between health-related quality of life and physical functioning in Antiretroviral-Naive HIV-infected patients. Methods: We conducted a cross-sectional study with HIV-infected patients older than 18 years, and naïve to antiretroviral therapy. The patients were evaluated for functional profile by pulmonary function (forced vital capacity, forced expiratory volume at one second, and Tiffeneau index), handgrip strength, and six-minute walk test in a cross-sectional study. HRQoL was evaluated by the 36-Item Short-Form Health Survey and its Physical (PCS) and Mental (MCS) Component Summaries. Multiple linear regression analyses were used to evaluate the association of predictor variables with PCS and MCS scores. Results: We found lower HRQoL among females patients, with far below average impairment of mental health component. Both male and female patients presented lower 6MWD function test values. Patients with dynapenia were older than patients without it, presented lower PCS mean score, lower family income, poor 6 MWD function test, lower FVC, and lower FEV1 t. Multivariable logistic regression analyses showed that Grip Strength, age and family income were predictor variables for Physical component of HRQoL. Female gender and smoking habit were predictive for the mental component of HRQoL. Conclusion: HRQoL in HIV, drug-naïve patients is predicted by level of dynapenia, smoking, income and gender. Therefore, lifestyle changes and active exercising can help to improve HRQoL in such patients.