Marcelo Pio de Almeida Fleck

Aplicação da versão em português do instrumento abreviado de avaliação da qualidade de vida "WHOQOL-bref"

INTRODUCTION: The need of short instruments to evaluate Quality of life determines World Health Organization Quality of Life Group (WHOQOL Group) to develop an abbreviated version of the WHOQOL-100, the WHOQOL-bref. The objective is to present the Brazilian field trial of the WHOQOL-bref. METHODS: WHOQOL-bref is composed by 26 questions divided in four domains: physical, psychological, social relationships and environment. The evaliation instrument, BDI (beck depression inventory) and BHS (beck hopelessness scale) were used in a 300 subjects sample in Porto Alegre, South Brazil. RESULTS/CONCLUSIONS: The instrument showed a good performance concerning internal consistency, discriminant validity, criterion validity, concurrent validity and test-retest reliability. The intrument allies good psychometric performance and practicity for use which puts it as an interesting option to evaluate quality of life in Brazil.

Desenvolvimento da versão em português do instrumento de avaliação de qualidade de vida da OMS (WHOQOL-100)

A Organizacao Mundial da Saude desenvolveu um instrumento para avaliacao de qualidade de vida atraves de um projeto colaborativo multicentrico. Sao descritas a metodologia e as diferentes etapas de desenvolvimento do instrumento original. A seguir, e apresentado o desenvolvimento da versao em portugues. Atraves de uma metodologia propria foi realizada a traducao, discussao em grupos focais com membros da comunidade, pacientes e profissionais de saude, seguida de retrotraducao. O objetivo dos grupos focais foi discutir a adequacao da traducao e da selecao de itens para avaliar qualidade de vida em uma cidade brasileira (Porto Alegre). O trabalho em grupo focal mostrou que o Instrumento de avaliacao de Qualidade de Vida da Organizacao Mundial da Saude (WHOQOL-100) apresenta condicoes para aplicacao no Brasil em sua versao original em portugues.

Aplicação da versão em português do instrumento de avaliação de qualidade de vida da Organização Mundial da Saúde (WHOQOL-100)

INTRODUCAO: O Grupo de Qualidade de Vida da OMS desenvolveu um instrumento de avaliacao de Qualidade de Vida, o WHOQOL-100 que esta traduzido para 20 idiomas (WHOQOL GROUP, 1998). A aplicacao do instrumento na versao em portugues e o objetivo do trabalho. METODOS: Foram aplicados em 250 pacientes provenientes de quatro grandes areas medicas (psiquiatria, clinica, cirurgia e ginecologia) de um hospital de clinicas de Porto Alegre, RS, e em 50 voluntarios-controles o Instrumento de Avaliacao de Qualidade de Vida da OMS (WHOQOL-100), o Inventario de Beck para a depressao (BDI) e a Escala de Desesperanca de Beck (BHS). RESULTADOS E CONCLUSOES:O Instrumento mostrou bom desempenho psicometrico com caracteristicas satisfatorias de consistencia interna, validade discriminante, validade de criterio, validade concorrente e fidedignidade teste-reteste. Concluiu-se que o instrumento esta em condicoes de ser usado no Brasil, sendo importante avaliar seu desempenho em outras regioes e em diferentes amostras de individuos.

Four Studies on How Past and Current Suicidality Relate Even When "Everything But the Kitchen Sink" Is Covaried.

T. E. Joiners (2004, in press) theory of suicidal behavior suggests that past suicidal behavior plays an important role in future suicidality. However, the mechanism by which this risk is transferred and the causal implications have not been well studied. The current study provides evaluation of the nature and limits of this relationship across 4 populations, with varying degrees of suicidal behavior. Across settings, age groups, and impairment levels, the association between past suicidal behavior and current suicidal symptoms held, even when controlling for strong covariates like hopelessness and symptoms of various Axis I and II syndromes. Results provide additional support for the importance of past suicidality as a substantive risk factor for later suicidal behavior.

O instrumento de avaliação de qualidade de vida da Organização Mundial da Saúde (WHOQOL-100): características e perspectivas

Quality of life evaluation has been growing in importance as a measure to evaluate results in medicine. Taking into account the absence of a quality of life instrument with a cross-cultural approach, World Health Organization developed a unique methodology to create it. Initially, the World Health Organization Quality of Life instrument (WHOQOL-100), with a hundred questions, was elaborated. The need of a short instrument to be used in extensive epidemiological studies caused WHO to develop a short 26-question version (WHOQOL-bref). Nowadays, a specific module to evaluate quality of life in HIV/Aids patients and a module to evaluate spirituality, religiousness and personal beliefs are being developed.A avaliacao de qualidade de vida vem crescendo em importância como medida de avaliacao de resultados de tratamento em medicina. A partir da constatacao da falta de um instrumento de avaliacao de qualidade de vida com um enfoque transcultural, a OMS desenvolveu uma metodologia unica para sua criacao. Inicialmente foi desenvolvido o World Health Organization Quality of Life (WHOQOL-100), instrumento composto de cem questoes. A necessidade de um instrumento mais curto para uso em extensos estudos epidemiologicos fez com que a OMS desenvolvesse a versao abreviada com 26 questoes (o WHOQOL-Bref). Atualmente, estao em desenvolvimento dois modulos: um especifico para avaliar qualidade de vida em pacientes com HIV/Aids e outro para avaliar espiritualidade, religiosidade e crencas pessoais.

Development and validation of the Portuguese version of the WHOQOL-OLD module.

OBJECTIVE The increasing proportion of older adults in the general population and the specific characteristics of this age group show the need for the development of specific instruments to measure quality of life in older adults. The study aimed at describing the development and validation of the Portuguese version of the World Health Organization Quality of Life for Older Persons (WHOQOL-OLD) module. METHODS The WHOQOL-OLD instrument was administered in a sample of 424 older adults in the city of Porto Alegre, Southern Brazil, in 2005. The questionnaire comprises 24 items divided into six facets: sensory abilities; autonomy; past, present and future activities; social participation; death and dying; and intimacy. Besides the WHOQOL-OLD module, the WHOQOL-BREF, BDI and BHS instruments were also applied. The instruments internal consistency was assessed using Cronbachs alpha coefficient. RESULTS The instrument showed adequate internal consistency (Cronbachs coefficients ranging from 0.71 to 0.88), discriminant validity (p<0.01), concurrent validity (correlation coefficients ranging from -0.61 to -0.50) and test-retest reliability (correlation coefficients ranging from 0.58 to 0.82). Findings concerning criterion validity need further studies. CONCLUSIONS The WHOQOL-OLD module is a useful alternative with good psychometric performance in the investigation of quality of life in older adults.

A systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials of ketamine in the rapid treatment of major depressive episodes

BACKGROUND There is growing interest in glutamatergic agents in depression, particularly ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist. We aimed to assess the efficacy of ketamine in major depressive episodes. METHOD We searched EMBASE, PsycINFO, CENTRAL, and Medline from 1962 to January 2014 to identify double-blind, randomized controlled trials with allocation concealment evaluating ketamine in major depressive episodes. Clinical remission, response and depressive symptoms were extracted by two independent raters. The primary outcome measure was clinical remission at 24 h, 3 days and 7 days post-treatment. Analyses employed a random-effects model. RESULTS Data were synthesized from seven RCTs employing an intravenous infusion and one RCT employing intranasal ketamine, representing 73 subjects in parallel arms and 110 subjects in cross-over designs [n = 34 with bipolar disorder (BD), n = 149 with major depressive disorder (MDD)]. Ketamine was associated with higher rates of clinical remission relative to comparator (saline or midazolam) at 24 h [OR 7.06, number needed to treat (NNT) = 5], 3 days (OR 3.86, NNT = 6), and 7 days (OR 4.00, NNT = 6), as well as higher rates of clinical response at 24 h (OR 9.10, NNT = 3), 3 days (OR 6.77, NNT = 3), and 7 days (OR 4.87, NNT = 4). A standardized mean difference of 0.90 in favor of ketamine was observed at 24 h based on depression rating scale scores, with group comparisons revealing greater efficacy in unipolar depression compared to bipolar depression (1.07 v. 0.68). Ketamine was associated with transient psychotomimetic effects, but no persistent psychosis or affective switches. CONCLUSION Our meta-analysis suggests that single administrations ketamine are efficacious in the rapid treatment of unipolar and bipolar depression. Additional research is required to determine optimal dosing schedules, route, treatment schedules, and the potential efficacy of other glutamatergic agents.

Reliability and validity of the WHOQOL BREF in a sample of brazilian outpatients with major depression

The present study assessed the psychometric properties of the Brazilian version of the World Health Organization’s Quality of Life Instrument – Short Version (WHOQOL BREF) in a sample of 89 adult outpatients with major depression. After analyses, the WHOQOL BREF showed good internal consistency, and was sensitive to improvement after treatment with antidepressants. Convergent validity between the WHOQOL BREF and the Beck Depression Inventory was statistically significant, as well as WHOQOL BREF’s ability to discriminate between outpatients on the basis of their level of depression. In conclusion, the WHOQOL BREF seems to be a psychometrically valid and reliable instrument that it is suitable for evaluating the quality of life of Brazilian-speaking depressed outpatients.

Psychometric properties of the World Health Organization Quality of Life instrument (WHOQoL-BREF) in alcoholic males: A pilot study

Objective: To evaluate criterion convergent and discriminant validity of the World Health Organization Instrument (WHOQoL-BREF) in evaluating quality of life and to verify its convergent validity with the Medical Outcomes study Short-forms (SF-36) and the Symptom Check List (SCL-90) instruments in male alcohol dependent patients who seek treatment at two Brazilian treatment centers. Methods: A cross-sectional study was performed, in which cases were divided in to two groups according to the severity of alcohol dependence, ascertained by the Short Form Alcohol Dependence Data scale (SADD). Results: The sample was comprised of 36 males, and 63.9% had severe dependence. Subjects with low/moderate dependence showed higher scores in all domains of the WHOQoL-BREF and in nearly all domains of the SF-36. Criterion validity and internal consistency in the WHOQoL-BREF were satisfactory. With regard to convergent validity between the WHOQoL-BREF and SF-36, most correlation coefficients were significant. Conclusions: The WHOQoL instrument proved to be satisfactory for evaluating quality of life in this sample.

Congruence of quality of life among infertile men and women: findings from a couple-based study

BACKGROUND It has been consistently demonstrated that infertility is associated with quality of life (QOL) impairments. Research to date has mostly focused on individuals reactions to infertility (mainly women), without an examination of how the partner is reacting to the same condition. The few studies that assessed QOL among couples did not use couple-based analyses, consequently not considering the intra-couple effects. The objectives of this study were to explore the congruence of QOL perception within infertile couples and to estimate the effect of depression levels on the congruence. METHODS In total, 162 couples were interviewed in an assisted reproduction clinic cross-sectionally. Subjects completed a socio-demographic form, World Health Organization Quality of Life-BREF and the Beck Depression Inventory independently. The statistical strategy was guided to ensure that subjects would be explored within pairs at all times and not as independent groups. Paired t-tests were run, and Cohens effect was estimated. Depression levels were controlled by linear multiple regressions and repeated-measures ANCOVAs. RESULTS Out of the five QOL domain scores, only two showed a significant discrepancy between partners (psychological and social relationship domains). Male depression was a significant predictor for all five QOL difference scores, whereas female depression was associated with three (overall, psychological and physical). Moreover, it was demonstrated that, except for the psychological domain and for the female depression on the physical domain, the load of depression as a predictor of the QOL difference scores was markedly low, accounting for not more than 7.5% of the variance of congruence between mens and womens QOL. CONCLUSION Our findings suggest that QOL scores do not differ markedly between spouses. Since QOL seemed similarly affected in both men and women, consideration might be given to offering interventions to them as a dyad. These results are not in line with the previous non-paired studies, and further investigations are required to address this dissimilarity.