Mario Alfredo De Marco

Qualidade de vida e adesão ao tratamento anti-retroviral de pacientes portadores de HIV

Foi realizada uma revisao da literatura cientifica sobre adesao terapeutica a highly active antiretroviral therapy e sobre a qualidade de vida dos pacientes portadores do HIV, indexada no MEDLINE no periodo entre 1998 e 2008. Foram incluidos estudos em pacientes maiores de 18 anos, publicados em portugues, espanhol ou ingles. Foram excluidos estudos de revisao, relatos de caso e cartas. Dos 21 estudos encontrados, 12 foram incluidos (tres ensaios clinicos, tres coortes prospectivos, seis transversais). A relacao entre qualidade de vida e adesao terapeutica permanece controversa, embora estudos descritivos apontem a possibilidade de uma relacao positiva. Os resultados podem ter sido influenciados por caracteristicas especificas dos ensaios clinicos descritos e mostram nao haver consenso sobre o impacto da adesao terapeutica sobre a qualidade de vida dos pacientes.

Revisão sistemática sobre as evidências de associação entre zumbido e depressão

UNLABELLED Tinnitus has been associated with several psychiatric disorders, however there are still several questions regarding such association. OBJECTIVE To assess the scientific evidence on the associations between symptoms of depression, depression, and tinnitus. METHOD A systematic review was performed using PubMed, Lilacs, and SciELO scientific databases. This review included studies published in Portuguese, Spanish, or English correlating tinnitus with depression; letters to the editor and case reports were excluded. RESULTS A total of 64 studies were identified, of which only 20 met the inclusion criteria and only 2 were case-control clinical trials. The majority of the studies (n = 18) found that depression is associated with tinnitus, either as a predisposition - resulting in poor adaptation to tinnitus or as a consequence of severe disease. CONCLUSION An overall assessment of all of the selected studies suggests at least 3 possible associations between depression and tinnitus: depression affecting tinnitus, tinnitus predisposing individuals to depression, and tinnitus appearing as a comorbidity in patients with depression. There is a high prevalence of depressive symptoms in individuals with tinnitus, but the mechanisms by which depression and tinnitus mutually interact, are not fully understood.

Quality of life and adherence to HAART in HIV-infected patients

Foi realizada uma revisao da literatura cientifica sobre adesao terapeutica a highly active antiretroviral therapy e sobre a qualidade de vida dos pacientes portadores do HIV, indexada no MEDLINE no periodo entre 1998 e 2008. Foram incluidos estudos em pacientes maiores de 18 anos, publicados em portugues, espanhol ou ingles. Foram excluidos estudos de revisao, relatos de caso e cartas. Dos 21 estudos encontrados, 12 foram incluidos (tres ensaios clinicos, tres coortes prospectivos, seis transversais). A relacao entre qualidade de vida e adesao terapeutica permanece controversa, embora estudos descritivos apontem a possibilidade de uma relacao positiva. Os resultados podem ter sido influenciados por caracteristicas especificas dos ensaios clinicos descritos e mostram nao haver consenso sobre o impacto da adesao terapeutica sobre a qualidade de vida dos pacientes.

Adaptação cultural do Chronic Liver Disease Questionnaire (CLDQ) para população brasileira

The aims of this study were the English-to-Portuguese translation and cross-cultural adaptation of the Chronic Liver Disease Questionnaire (CLDQ) for use in Brazil. The instrument was translated from the original language, English, to Portuguese by the authors, and was subsequently reviewed and evaluated as to the degree of difficulty of the translation and equivalence, by bilingual translators. The questionnaire was then applied to 20 randomly selected patients with chronic liver disease. Patients had no difficulty understanding the questionnaire and considered all the questions applicable. The cultural equivalence of the CLDQ was demonstrated, without requiring changes in the original translation. The translation into Portuguese and cross-cultural adaptation of the CLDQ successfully completed this important stage for its validation and use in Brazil.

Entrevista com os familiares: um instrumento fundamental no planejamento da revelação diagnóstica do HIV/Aids para crianças e adolescentes

The scope of this study was to present the participation of caregivers in creating strategies for disclosure of their condition to HIV-positive children, as well as discussing the interventions that might contribute to overcoming the difficulties that commonly prevent family members from accepting this process. The participants included 23 caregivers of 18 patients referred for diagnosis disclosure, monitored at two pediatric AIDS units in the municipality of Sao Paulo, Brazil. This is a qualitative study and data were collected through semi-structured interviews. The results showed that legitimating reasons why caregivers are reluctant to disclose the diagnosis to the children, as well as their motivations, are interventions that contribute to reduce resistance, facilitating the acceptance of disclosure. The collaboration of caregivers has provided valuable insights for conducting the work, and has enabled the establishment of a receptive and supportive relationship minimizing inhibitions that could be harmful to the continuity of the process.

Semiologia integrada: uma experiência curricular de aproximação antecipada e integrada à prática médica

An early clinical exposure program was developed with the aim of avoiding fragmentation and stereotyped behaviors during medical training. Second-year medical students received an introductory course on Integrated Basic Clinical Skills (BCS), which included hospital rounds followed by case discussions led jointly by faculty members from medical psychology and various clinical areas (internal medicine, pediatrics, obstetrics, gynecology, and geriatrics). Special care was taken to provide a model in which medical students could learn about biological, psychological, and social aspects of illness within the same format. The article discusses the objectives, logistics, and staff of the course, based on the experience at the Federal University in Sao Paulo. The model offers an integrated model for both students and faculty. Further studies are necessary to evaluate these preliminary findings.

Validation of the Brazilian version of Chronic Liver Disease Questionnaire.

PurposeThe aim of this study was to validate the Chronic Liver Disease Questionnaire (CLDQ) for use in Brazilian population.MethodA total of 200 patients with chronic liver disease and varying disease severity answered a socio-demographic questionnaire, t CLDQ, and the Medical Outcome Study Short Form 36 (SF-36). Patients returned in 1–15 days to answer CLDQ again. The Cronbach’s alpha of the total CLDQ score was 0.95 and fluctuated between 0.69 and 0.83 in its six domains.ResultsThe intra-class correlation between total CLDQ scores in two evaluations was 0.97 and in all domains was >0.93. CLDQ was moderately correlated with the SF-36, 0.63 (total CLDQ vs. vitality, SF-36), 0.62 (CLDQ and mental health, SF-36), 0.62 (preoccupation, CLDQ, vs. General Health, SF-36), 0.59 (fatigue, CLDQ, vs. vitality, SF-36), 0.59 (activity, CLDQ, vs. vitality, SF-36), and 0.59 (fatigue, CLDQ, vs. mental health, SF-36). The highest scores were found in non-cirrhotic group. Child A patients had higher average scores than Child B and C groups in all domains, while patients with MELD <15 scored higher than patients with MELD ≥15.ConclusionCLDQ-BR was validated in Brazilian population and was appropriate for use in patients with liver disease of different etiologies and degrees of severity.

Avaliação da evolução da empatia em alunos do quarto ano da graduação em medicina da Unifesp em 2012

OBJECTIVE: This study consisted of reassessing empathy demonstrated by fourth-year medical students at Unifesp after a prior evaluation in 2009 when the students were in the first year of the course, and a consequent comparison of the results obtained. METHOD: A validated instrument known as the Empathy Inventory (Falcone, 2008) was used to measure empathy among 80 fourth-year students at Unifesp Medical School. The inventory features 40 questions in a Likert scale that assess four factors related to the ability to empathize: Adoption of a Perspective, Interpersonal Flexibility, Altruism and Emotional Sensitivity. RESULTS: Empathy among medical students at Unifesp showed no statistically significant change from 2009 to 2012. CONCLUSION: The increased contact that students have with patients at the beginning of the course combined with the high number of curricular subjects focused on the humanities possibly explains the result. Students at the institution are able to develop the technique giving it a more humanist character and learning from the beginning how to treat patients, rather than illnesses.

Factors associated with depressive symptoms in a sample of Brazilian medical students

OBJETIVOS: 1- Verificar prevalencia de sintomas depressivos nos estudantes de medicina do 1o a 4o ano atraves do Inventario de Depressao de Beck (IDB). 2- Estabelecer correlacoes entre os fatores questionados e a incidencia de maior ou menor pontuacao no IDB. 3- Investigar relacao entre a prevalencia de sintomas depressivos e a procura por atendimento psicologico oferecido pela Universidade Lusiada. METODO: Desenho transversal realizado com 290 academicos do curso de medicina, do 1o ao 4o ano. Realizada aplicacao do IDB, questionario socio-demografico e avaliacao sobre satisfacao com curso. RESULTADOS: Da amostra estudada, 59% saomulheres e 41% homens. O escore medio do IDB foi de 6,3 com DP de 5,8. Aprevalencia total desintomas depressivos foi de 23,1%. As seguintes relacoesapresentaram significância estatistica (P<0,05): Dosestudantes queafirmam que o curso nao corresponde as expectativas iniciais,dosestudantes insatisfeitos com o curso e dosestudantes procedentes do Interior do Estado(20,5%; 12,5%e 24,4% da amostra total, respectivamente), 40%, 36,1% e 36,4% respectivamente, tem escore compativel com algum grau de depressao. CONCLUSAO: O presente estudo mostrou que ha maior prevalencia de sintomas depressivos nos estudantes de Medicina que na populacao geral

Saúde mental nas práticas em saúde - a experiência do PROLIG

This paper presents the experience of the Psychosocial Service of Integrated Attention in Health (SAPIS) in a consultation-liaison psychiatry program (called PROLIG). The SAPIS was implemented in June 2002 at the Sao Paulo Hospital (HSP) to promote a broad attention to general and specific hospital psychosocial needs and also to reorganize the inclusion of mental health professionals in ambulatories and wards. This paper aims at describing the role of psychologists as mental health liaison professionals attending specific demands at these units of HSP. Their task involves providing psychological assistance to the patient and his family, as well as being a mental health specialist to the multi-professional team. Nevertheless, some difficulties have been found to implement and maintain these proposals. Concluding, psychologists as mental health liaison professionals promote changes in the health care offered by this institution; however, a deeper reflection and engagement of this institution as well as an implementation of health care policies are demanded to enable structural changes for the construction of an integral and integrated effective practice.