[Application of the Portuguese version of the instrument for the assessment of quality of life of the World Health Organization (WHOQOL-100)]

Spirituality and Caregiver Burden of People with Intellectual Disabilities: an Empirical Study

In recent years, interest in topics related to disabilities has grown. However, little attention has been devoted to people who constantly care for family members with an intellectual disability (ID). Thus, this study evaluated the relationship between the caregiver burden of people with intellectual disabilities and spirituality. The applied method was quantitative, exploratory, descriptive, and cross-sectional. The instruments used to collect data were a sociodemographic questionnaire, including questions extracted from the WHOQOL-100 (spiritual domain), and the following scales: Centrality of Religiosity; Brief Spiritual Religious Coping; Religious and Spiritual Struggles; Zarit Burden Interview and Satisfaction with Life Scale. One hundred twenty-nine people participated in the study. The sample was categorized as “highly religious” (57.3%), and 61.24% had an overload classified between moderate (36.43%) and severe (24.81%). The use of positive spiritual/religious coping methods was considered medium (M  = 3.44), and religious and spiritual struggles were low (M  = 1.71). Results show that those who considered themselves “spiritual and religious” highly use positive spiritual religious coping and score light burden and more life satisfaction. Such results indicate the importance of being attentive to the role of this dimension when planning emotional, psychological, and existential/spiritual support assistance. Public policies should consider the spiritual and religious dimension of those exclusively caring for people with intellectual disabilities. Studies focusing on how spiritual care can be provided to this population should be intensified.

Preliminary Assessment of the Quality of Life and Daily Burden of Caregivers of Persons with Special Needs: A Questionnaire-Based, Cross-Sectional Survey

Caregivers of persons with special needs (PSN) experience a variety of burdens and elevated levels of stress and anxiety throughout their lives, leading to a physical, psychological, emotional, social, and financial overload. This analytical study with a cross-sectional design and a quantitative approach aimed to appraise quality of life (QoL), reflecting the daily workload of informal family caregivers of PSN.

METHODS

Four structured, validated questionnaires were utilised: sociodemographic, WHOQOL-bref, Zarit Burden Interview, and Functional Independence Measure Scale in 60 anonymous volunteered respondents.

RESULTS

The informal caregivers were middle-aged mothers (81.7%), married (55%), stay-at-home spouses (60%) with high school degrees (51.6%), providing a care for their relatives with special needs for more than 20 years (41.8%). Most of the PSN were diagnosed with autistic spectrum disorder (ASD, 61.8%), had a wide spectrum of intellectual deficits, and required constant support for their basic needs. They were mainly adolescent males without physical limitations (83.4%) on disorder-specific medications (90%). The study revealed that those caregivers had a median perception of QoL considering four essential domains, with a highest score recorded for the physical domain (64.3 +/- 16.1 SD). A moderate burden level prevailed, revealing neither a correlation between the workload expressed by caregivers and the patient's functional capacity, nor in the performance of daily self-care tasks (Spearman correlation test p > 0.05), apart from the environmental domain (mild correlation = 0.335, p < 0.05).

CONCLUSIONS

The reported average level of overload associated with QoL of informal caregivers exists, affecting a vast proportion of the respondents. The absence of a direct association between workload and the functional capacity/daily self-care tasks can be related to the significant personal dedication of family caregivers, regardless of their socioeconomic status.

The Quality of Life among Siblings of Autistic Individuals: A Scoping Review

Autism spectrum disorders are a heterogeneous group of neurodevelopmental disorders presenting at a tender age, defined by qualitative deficits in social interactions and communication, thus having a substantial influence on the subject's family unit. Quality of life (QoL) refers to a person's perspective of their life situation, cultural and value background, objectives, expectations, and standards. When focusing on childhood and adolescence, age-related changes should be considered. For this scoping review, the authors used three peer-review literature database sources (PubMed/MEDLINE, Scopus, and ERIC) to delve deeper into components of the QoL of non-autistic siblings of autistic individuals. At the completion of the eligibility phase, 9 studies were included out of the 96 initial records. A total of 4/9 articles (45%) compared the non-autistic siblings of autistic individuals to the siblings of non-autistic people, while 3/9 articles (33%) compared the first group to the non-autistic siblings of patients with other chronic diseases. A total of 5/9 studies adopted specific questionnaires to evaluate QoL. Results from 6/9 articles revealed that the autism condition has varying effects on non-autistic siblings' QoL. According to the considered research, non-autistic siblings of autistic individuals experienced decreased psychological well-being, less perceived social support, increased aggressiveness and conflict-proneness, and higher levels of anxiety and stress impacting their QoL. The present findings provide important implications for additional and more punctual studies in this sector. Furthermore, as being a non-autistic sibling of an autistic individual is commonly undervalued, this review advocates the need to organize and improve support services for siblings.

Health Problems in Individuals With PWS Are Associated With Lower Quality of Life for Their Parents: A Snapshot in the Brazilian Population

Prader-Willi syndrome (PWS) is a complex genetic disorder requiring interdisciplinary team monitoring and intensive care by parents. So far there is little information on people with PWS in Brazil. Our aim was to describe health problems and treatments used by people with PWS in Brazil and their relationship to their parents' quality of life. Parents answered questionnaires about their child's medical and exercise history, behavior problems, sociodemographic characteristics, and their own quality of life. Results: The responses of the participants showed similar health problems as in other countries. Anxiety and tantrums were the behavioral problems most commonly cited by parents. Parents of people with PWS had lower scores in respect of quality of life than the Brazilian population. Behavioral problems in individuals with PWS were negatively associated with their parents' quality of life. Behavioral and medical conditions in the children were associated with reduced quality of life in the parents. We conclude that heath care should not only be directed toward those with PWS, but also their parents.

Factors associated with prehypertension and hypertension among healthcare workers working in high-complexity services

The objective was to estimate the prevalence and factors associated with prehypertension and hypertension among health workers who work in high-complexity services for critically-ill and chronic patients. An epidemiological, cross-sectional study was carried out with 490 health workers in the macroregional region of Northern Minas Gerais, Brazil. The dependent variable blood pressure (BP) was categorized as normal BP, prehypertension and hypertension. Multinomial Logistic Regression was used for the multiple analysis. The prevalence of arterial hypertension was 21.8% and that of prehypertension was 25.9%. The chances of developing arterial hypertension and prehypertension were higher in male professionals, aged ≥40 years, in civil servant workers and those who were obese or overweight. The use of continuous medication and night shift work were associated with hypertension and prehypertension, respectively. The prevalence of arterial hypertension in the group of workers was lower than that of the Brazilian population. It is necessary to carry out studies with workers from this group and investments are required in preventive measures that encourage a change to a healthy lifestyle.

Fecal incontinence and quality of life assessment through questionnaires

Background: Fecal incontinence causes a big impact on patient's quality of life. Our study analyzed the main questionnaires about fecal incontinence available internationally, aiming to delineate vantages and limitations of these instruments and their application, to mention the cultural aspects involved in the process of development and validation, as well as to suggest a reflection about the complexity of this matter. Results: Four of the instruments (Pescatori score, FISI, MSKCC bowel function instrument, and LARS score) do not include quality of life, working only as diagnostic tools. Two others, ‘Jorge and Wexner Fecal Incontinence score’, and ‘St Marks’ Fecal incontinence grading system’ can diagnose and grade fecal incontinence, however they are very subtle in assessing quality of life. The ‘EORTC Colorectal Cancer-specific’, on the other hand, focuses exclusively on quality of life. Although the ‘FIQL’ questionnaire assesses quality of life related to fecal incontinence, it does not measure leakage. Lastly, the ‘RAFIS’ assesses both aspects but too superficially. Conclusion: None of the questionnaires analyzed were able to simultaneously assess both fecal incontinence and quality of life successfully. Furthermore, the concepts related to fecal incontinence have different meanings depending on the cultural and psychosocial context. These differences are even greater when individuals of developed countries like the ones where these questionnaires were developed are compared to the ones of developing countries, such as Brazil, which makes its very hard for these instruments to be used universally.

Distance learning during social seclusion by COVID-19: Improving the quality of life of undergraduate dentistry students

BACKGROUND

Social isolation is ongoing worldwide with the aim to stem the spread of the novel coronavirus SARS-CoV-2 responsible for the COVID-19 pandemic. However, social isolation leads to significant psycho-emotional changes. This study aimed to assess the effect of distance education (DE) activities implemented due to social isolation, on the quality of life of undergraduate dentistry students.

METHOD

An e-questionnaire (Google Forms^® ) was administered to identify specific DE activities after social isolation and included the World Health Organization Quality of Life (WHOQOL)-Bref questionnaire. The e-questionnaire was sent 14 days after the initiation of social isolation, remaining available for 48 hours. Cronbach's alpha and the means of the quality-of-life domains were calculated and analysed using the Friedman/Dunn and Spearman's correlation tests. After ranking, chi-squared and Fisher's exact tests plus multinomial logistic regression were performed (SPSS, P < .05).

RESULT

There was an excellent internal consistency of WHOQOL-Bref (α = 0.916), and the mean quality of life (0-100) was 70.66 ± 12.61. The psychological domain was the most affected (P < .001). The social domain exhibited the weakest correlation with overall quality of life (P < .001, r = 0.688). The use of the Internet, cell phones and streaming media increased, although all students had DE activities. In the multivariate analysis, attending virtual meetings (P = .028) and performing DE activities in an office/study room (P = .034) were significantly associated with good quality of life.

CONCLUSION

Facing social isolation never previously experienced by this generation, undergraduate dentistry students are at risk of reduced quality of life. Therefore, performing DE activities through devices with teacher-student interaction is a key coping tool.

Instrumento WHOQOL-100 e políticas públicas: avaliação da qualidade de vida de população alvo de política habitacional

Resumo O ambiente é um dos determinantes sociais da saúde. No Brasil, as habitações sociais, financiadas por políticas públicas, tendem a ser erguidas em espaços desprovidos de infraestrutura urbana e a posse da casa se acompanha de incertezas na condução da vida cotidiana. Este trabalho visa investigar o uso do questionário de qualidade de vida WHOQOL - 100 como instrumento de análise da qualidade de vida de uma população atendida por política habitacional, integrando os campos da saúde coletiva e do planejamento urbano. O questionário foi respondido por 101 moradores de um conjunto habitacional de São José dos Campos, um município paulista de grande porte. Encontraram-se baixos escores de autoavaliação de qualidade de vida, ambiente e subjetividade comparados aos dados disponíveis em publicações acadêmicas que avaliam, no geral, populações adoecidas. Os resultados permitiram avaliar de modo objetivo a relação entre ambiente e qualidade de vida, subsidiando a formulação e implantação de políticas sociais integradas às habitacionais para garantia dos direitos sociais de populações carentes.

Oral health-related quality of life in individuals with severe asthma

Objective:

To evaluate oral health-related quality of life (OHRQoL) among individuals with severe asthma, comparing it with that observed among individuals with mild-to-moderate asthma and individuals without asthma.

Methods:

We conducted a cross-sectional study of 125 individuals: 40 with severe asthma; 35 with mild-to-moderate asthma; and 50 without asthma. We calculated the decayed, missing, and filled teeth (DMFT) index, as well as the Periodontal Screening and Recording index, and determined the stimulated salivary flow rate. We applied three structured questionnaires: the 14-item Oral Health Impact Profile (OHIP-14); the Medical Outcomes Study 36-Item Short-Form Health Survey, version 2 (SF-36v2); and the Work Ability Index (WAI).

Results:

Periodontitis and reduced salivary flow were both more common in the severe asthma group than in the mild-to-moderate asthma and no-asthma groups. In addition, the WAI scores were lower in the severe asthma group than in the mild-to-moderate asthma and no-asthma groups, as were the scores for all SF-36v2 domains. The individuals with severe asthma also scored lower for the OHIP-14 domains than did those without asthma. Although the mean DMFT index did not differ significantly among the groups, the mean number of missing teeth was highest in the severe asthma group. Strong correlations between the SF-36v2 Component Summaries and poorer OHRQoL were only observed in the severe asthma group.

Conclusions:

Severe asthma appears to be associated with poorer oral health, poorer OHRQoL, a lower WAI, and lower scores for SF-36v2 domains.

Long-Term Morphologic Changes on Sagittal Synostosis Patients Who Underwent a Modified Pi Technique

BACKGROUND

There are paucity of studies focused on the long-term assessment of the craniofacial changes after a pi-plasty procedure and self-reported quality of life outcomes. Thus, this study aimed to assess long-term morphologic changes and quality of life of patients with sagittal synostosis who underwent surgery with a modified pi-plasty.

METHODS

Consecutive patients with sagittal synostosis who underwent surgery and had more than 5 years of follow-up and standard preoperative and 1, 3, and 5 years right profile view photographs were included. Nasofrontal angle and angle of total facial convexity were evaluated using computerized photogrammetric measurements. Additionally, quality of life outcome was evaluated by the Quality of Life Scale Short Form.

RESULTS

The total facial convexity angle and nasofrontal angle increased significantly (P < 0.05), with a P-value of 0.013 and 0.012, respectively. Patients had quality of life scores >80 in all of the 4 domains, with the highest scores being: physical health domain 80.0 ± 0, psychologic domain 85.0 ± 5, social relationships domain 86.6 ± 0, and environmental domain 98.13 ± 2.42.

CONCLUSION

Facial angles significantly changed over 5 years of follow-up. Self-reported quality of life instrument showed that patients are satisfied with their own appearance, contributing positively to their quality of life.

Exercise program combined with electrophysical modalities in subjects with knee osteoarthritis: a randomised, placebo-controlled clinical trial

BACKGROUND

It is not yet clear which of the various electrophysical modalities used in clinical practice is the one that contributes most positively when added to an exercise program in patients with knee osteoarthritis (OA). The aim of the present study was to analyze the clinical effects of the inclusion of interferential current therapy (ICT), shortwave diathermy therapy (SDT) and photobiomodulation (PHOTO) into an exercise program in patients with knee OA.

METHODS

This prospective, five-arm, randomised, placebo-controlled trial was carried out with blinded participants and examiners. We recruited 100 volunteers aged 40 to 80 years with knee OA. Participants were allocated into five groups: exercise, exercise + placebo, exercise + ICT, exercise + SDT, and exercise + PHOTO. The outcome measures included Western Ontario and McMaster Universities (WOMAC), numerical rating pain scale (NRPS), pressure pain threshold (PPT), self-perceived fatigue and sit-to-stand test (STST), which were evaluated before and after 24 treatment sessions at a frequency of three sessions per week.

RESULTS

In all groups, there was a significant improvement (p < 0.05) in all variables over time, except pressure pain threshold. We observed significant differences (p < 0.05) between the groups for WOMAC function (exercise vs. exercise + placebo, mean difference [MD] = 5.55, 95% confidence interval [CI] = 3.63 to 7.46; exercise vs. exercise + ICT, MD = 3.40, 95% CI = 1.46 to 5.33; exercise vs. exercise + SDT, MD = 4.75, 95% CI = 1.85 to 7.64; exercise vs. exercise + PHOTO, MD = 5.45, 95% CI = 3.12 to 7.77) and WOMAC pain, with better scores achieved by the exercise group. However, these differences were not clinically relevant when considering the minimum clinically important difference.

CONCLUSION

The addition of ICT, SDT or PHOTO into an exercise program for individuals with knee OA is not superior to exercise performed in isolation in terms of clinical benefit. clinicaltrials.gov: NCT02636764, registered on March 29, 2014.

Can whole body vibration exercises promote improvement on quality of life and on chronic pain level of metabolic syndrome patients? A pseudorandomized crossover study

Quality of life (QoL) is one of the most important health outcome concepts expressed subjectively. Chronic pain (CP) is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Taking into account the poor QoL and the CP already described in metabolic syndrome (MSy) individuals, this study aimed to evaluate the effects of whole body vibration exercises (WBVE) on these parameters in this population. Thirty-three MSy patients were divided in subgroups A [whole body vibration exercise group (WBVeG), n = 17, 15 females/2 males, 61.1 ± 8.4 yr] and B (control group, n = 16, 14 females/2 males, 58.2 ± 9.1 yr). Subgroup A performed 10 sessions (2 times/wk) of WBVE (18 min/session, with a frequency from 5 up to 14 Hz and a peak-to-peak displacement of 2.5, 5.0, and 7.5 mm) on a side-alternating vibrating platform (VP). Subgroup B did the same protocol, but the VP was turned off. The individuals answered the World Health Organization Quality of Life bref (WHOQoL-bref) questionnaire before the first and after the 10th session. The chronic pain level (CPL) was measured by a numeric rating scale (0-10) before and at the end of each session. Significant improvements were found in physical health (P = 0.05) and psychological health (P = 0.04) domains of WHOQoL-bref in WBVeG. A significant acute reduction of the CPL was found in the WBVeG after the protocol, considering the first session and at the last session. WBVE marginally improved physical health and psychological health and decrease the CPL in acute interventions.NEW & NOTEWORTHY Metabolic syndrome patients experience poor quality of life, frequently associated with lack of exercise and bad dietary habits. Additionally, factors such as obesity, neuromusculoskeletal impairment, and peripheral endothelial dysfunction result in a chronic pain level. Whole body vibration exercise might represent a suitable physical therapy, since it is easy to perform, low cost, safe, and capable of promoting an improvement of quality of life and reducing chronic pain level during acute interventions in metabolic syndrome individuals.

Development of an education integrated design framework for the physical space of nursing homes in relation to life expectancy of the older people

The purpose of this research is to find design variables effective on education integration with physical spaces of nursing homes in association with life expectancy of older people. Delphi technique was used to obtain the design variables by which the education integration with physical spaces of nursing homes can be achieved. Subsequently, in order to investigate the modifying effect of education integrated physical space on life expectancy of the elderly, questionnaires were sent to 50 local researchers and experts in the field of ageing. Results showed a significant and positive correlation between education integrated physical space and life expectancy indicators (p < .05). The results suggest that as per expert opinions, designing a physical space integrated with education could increase the life expectancy of older people.

[Dental pain among psychoactive substance users in CAPS AD in Vitoria, Vila Velha and Serra, ES, Brazil]

Toothache is a public health problem that causes great inconvenience to psychoactive substances users. The objective was to verify the prevalence of dental pain and its associations among psychoactive substances users from Alcohol and Drug Psychosocial Care Centers (CAPS AD) in Vitoria, Vila Velha and Serra, Espírito Santo, Brazil. A transversal study was conducted with 280 participants between June 2015 and February 2016, using five scripts: one for socio-demographic data and health perception; another for oral health; the Oral Health Impact Profile; the Alcohol Smoking and Substance Involvement Screening Test and the World Health Organization Quality of Life Test. Data were organized in frequency tables and analyzed with the SPSS 20 statistical package. Comparisons were made with Fisher's test and the Odds Ratio (OR) was used to check the strength of the association between the variables. The prevalence of pain in the population studied was 59.3%, and individuals whose quality of life was impacted due to their oral conditions were 2.2 times more likely to report toothache in the last 6 months. The population studied showed a high prevalence of dental pain and the study indicates that dental pain interferes in the quality of life of psychoactive substances users who are treated at CAPS AD services in these three cities.

Assessment of Anthropometric and Physical Health Indicators before and after Pituitary Surgery in Patients with Nonfunctioning Pituitary Adenomas, Acromegaly, and Cushing Disease

INTRODUCTION

Individuals with pituitary adenomas may have organic consequences of their disease or therapy, and psychological changes can compromise their quality of life (QoL). This study aimed to determine the anthropometric profile and health indicators of patients with pituitary adenoma before and after pituitary surgery.

METHODS

Forty-four patients were included in this study. Out of these, 22 patients had nonfunctioning adenomas (50%), 17 acromegaly (38.6%), and 5 patients with Cushing's disease (11.4%). Anthropometric measurements included body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). Health indicators included body fat percentage (BF%), basal metabolic rate (BMR), maximal oxygen uptake (VO₂ max), and hand grip strength. Physical activity level (the International Physical Activity Questionnaire [IPAQ]), subjective perception of health, body image (Body Shape Questionnaire), body satisfaction (Stunkard Figure Rating Scale) were used.

RESULTS

The mean patient age was 47.2 ± 14.6 years; of which 25 were women (56.8%). Before surgery, 75.0% were overweight or obese, 84.1% had WC with risk of metabolic complications, and 90.0% had WHR with cardiovascular risk. There was a high BF% in 56.4% of cases, low BMR in 65.1%, lower VO₂ max in 16.2%, and below-average grip strength in 88.6%. Hypopituitary patients had poorer cardiorespiratory fitness. The IPAQ showed reduction in physical activity, and 79.5% of patients were dissatisfied with their body image. Patients with nonfunctioning adenomas had better perception of their health while those with Cushing's disease had more distorted body image. Postoperatively, patients with acromegaly showed improvement in WHR and physical activity level, and patients with Cushing's disease showed improvement in anthropometric variables.

CONCLUSIONS

These findings emphasize the need for continuous monitoring of this population for anthropometric indicators associated with metabolic and cardiovascular comorbidities as well as body satisfaction.

Biopsychosocial factors associated with the frailty and pre-frailty among older adults

Frailty is a multidimensional geriatric syndrome associated with specific biopsychosocial factors in each population. This was a cross-sectional observational study designed to determine the biopsychosocial factors associated with frailty and pre-frailty in older adults in a community in Salvador, Brazil. The stages of frailty were collected in 413 older adults: 34.9% frail, 54.5% pre-frail, 10.6% robust. In the multinomial regression model, age (p = .018), functionality for instrumental activities of daily living (p = .026), risk for falls (p = .006), family functionality (p = .031) and the physical domain of quality of life (p = .004) had an independent association with frailty. Risk for falls (p = .004), family functionality (p = .004) and the environment domain of quality of life (p = .037) were independently associated with pre-frailty. The findings provide support to interventions in a way that contributes to prevention or reversal of frailty.

Impact of AferBio® on quality of life and chemotherapy toxicity in advanced lung cancer patients (AFERBIO study): protocol study for a phase II randomized controlled trial

BACKGROUND

Lung cancer patients undergoing palliative chemotherapy exhibit many symptoms related to the disease, such as adverse events and infectious complications during treatment, which impacts directly their health-related quality of life (HRQOL). Nutritional status is a relevant aspect among advanced cancer patients under palliative care and food supplementation has the potential to reduce treatment-related adverse effects and improve the nutritional status. The product named AferBio® is a fermented supplement that has been described as able to provide some benefits, including the capacity to potentiate the effects of anticancer drugs, by promoting the reduction of side effects and ultimately improving HRQOL.

METHODS/DESIGN

A Phase II double-blind placebo-controlled randomized clinical trial to assess the use of food supplementation with AferBio® in Stage IIIB or IV non-small cell lung cancer (NSCLC) patients beginning a second-line palliative mono-chemotherapy. The primary goal is to compare HRQOL scores between the arms of the study over time. The ten first patients included in the present study will undergo an AferBio®toxicity-testing (non-randomized phase). If no significant toxicity is found, the study will move on to the randomized phase. All patients will be randomized in blocks at a 1:1 ratio using the online tool REDCap. ECOG-PS (0-1 versus 2) criteria will be used for stratification. All patients included in the trial will be evaluated at baseline and at each chemotherapy cycle. Each evaluation will include the following: HRQOL (EORTC QLQ-C30, LC13 and IQualiV-Lung), ECOG-PS, anthropometric measurements, clinical and laboratory toxicity assessment and response evaluation.

DISCUSSION

During palliative systemic therapy in advanced cancer patients, one of the main goals is the improvement and maintenance of HRQOL, which can be negatively affected by cancer symptoms, cancer- or treatment-related psychosocial difficulties, and chemotherapy toxicity. Thus, much research has been dedicated to the development of new and more effective and/or less toxic cancer therapies. The present study is justified by the testing of a novel food supplement that may reduce some toxicities, thus, having a potential positive impact on the HRQOL of lung cancer patients. The product in question (AferBio®) is already available for sale in Brazil, but has not yet been fully tested in cancer patients.

TRIAL REGISTRATION

This Trial was registered on March 19, 2018 with ClinicalTrials.gov , NCT03469063. Protocol version: 2.0 from March 26, 2018. Trial status: Patient enrollment in the study began in April, 2018.

Severity of oral lichen planus and oral lichenoid lesions is associated with anxiety

OBJECTIVES

Oral lichen planus (OLP) and oral lichenoid lesions (OLL) are chronic inflammatory diseases whose symptoms can impair patient's quality of life (QoL). Psychological factors seem to play an important role in these diseases. This study aimed to determine the impact of oral health and anxiety levels on the QoL of patients with OLP and OLL.

PATIENTS AND METHODS

This was a cross-sectional study composed of OLP and OLL patients and a control group matched by age and sex with no autoimmune/inflammatory or malignant oral lesions. Anxiety levels and oral health impact on QoL were assessed using the Hamilton Anxiety Scale (HAM-A) and the Oral Health Impact Profile-14 (OHIP-14), respectively. The instruments were filled through personal interview before starting the treatment for oral lesions.

RESULTS

A total of 87 patients diagnosed with OLP (n = 45) and OLL (n = 42), and 87 controls were included in the study. Statistical differences were observed for the psychic and somatic anxiety dimensions between severities of diseases. Patients with OLP or OLL had higher scores for the OHIP-14 dimensions physiological discomfort and social limitation compared with controls. In addition, higher scores for physical pain, physical disability, social disability, and handicap were detected among patients with greater severity.

CONCLUSION

Greater severity of OLP and OLL seems to be associated with increased levels of anxiety, higher scores of oral health impact profile, and decreased QoL.

CLINICAL RELEVANCE

Patients with severe OLP/OLL may benefit from additional therapeutic treatments, such as psychological and/or psychiatric management, concomitant to treatment specific to oral lesions.

Impacto da disfunção motora na qualidade de vida em pacientes com Acidente Vascular Encefálico

O Acidente Vascular Encefálico (AVE) é uma das maiores causas de seqüelas permanentes que geram incapacidade funcional. Esses pacientes apresentam dificuldade para realizar as atividades da vida diária, tornando-se dependentes, em escala correspondente à gravidade da lesão levando a uma menor qualidade de vida (QV). Objetivo: avaliar o impacto do AVE e suas seqüelas na QV desses indivíduos. Métodos: Foram avaliados 11 indivíduos que apresentavam idade média de 56,75 ± 10,25 anos e tempo de lesão de 48 ±32,7 meses. Para a coleta de dados, o questionário SF-36 foi aplicado individualmente. As pontuações de cada componente foram calculadas pelo somatório dos itens de cada questão e transformadas em uma escala de 0 a 100 pelo cálculo de Raw Scale. Resultados: O SF-36 evidenciou uma diminuição em todos os itens da avaliação. Foram encontradas as seguintes medias de pontuações em cada domínio avaliado: Capacidade Funcional 40,45, Aspectos Físicos 0,91, Dor 34,09, Estado Geral de Saúde 47,27, Vitalidade 50, Aspecto Social 47,09, Aspectos Emocionais 10,82 e Saúde Mental 52. Conclusão: Esses dados demonstram o impacto negativo do AVE na QV desses indivíduos.

Correlation between religiosity, spirituality and quality of life in adolescents with and without cleft lip and palate

OBJECTIVE

to correlate spirituality and religiosity with quality of life of adolescents with and without cleft lip and palate.

METHODS

cross-sectional and correlational study involving two groups: case group (n = 40) and comparison group (n = 40). The Duke University Religion Index (DUREL) and the World Health Organization Quality of Life Bref were used for data collection. The Mann-Whitney, Chi-Square, Student's t-test and Pearson's correlation tests were used in the statistical analyses, with a significance level of 5% (p ≤ 0.05).

RESULTS

organizational religiosity and overall quality of life were significantly higher in the case group (p = 0.031 and p = 0.012, respectively). As for quality of life, the Environment Domain was significantly higher in the case group (p < 0.001). In the correlation between religiosity and spirituality, non-organizational religiosity had a strong correlation (r = 0.62) with organizational religiosity (p < 0.001). In the correlation of religiosity and spirituality with quality of life, only a moderate correlation between spirituality and overall quality of life was identified (r = -0.35, p = 0.026).

CONCLUSION

there was no relationship of religiosity and spirituality with quality of life among adolescents with cleft lip and palate for most aspects evaluated.

The effect of religiosity during childhood and adolescence on drug consumption patterns in adults addicted to crack cocaine

BACKGROUND

Although many studies suggest that religiosity is a protective factor against drug use, there is little information on its effect on drug consumption patterns of those who do use drugs.AimsWe aimed to examine if there is any relationship between religiosity during childhood and adolescence, and drug consumption in adult crack users.

METHOD

We performed a cross-sectional study of adults addicted to crack cocaine. Logistic regression analysis was used to estimate the odds ratio for the association between religious history in the age groups 8-11, 12-14 and 15-17 years and outcome variables.

RESULTS

From a total of 531 respondents, religious involvement during childhood and adolescence was correlated to less frequent onset of drug consumption before 18 years (odds ratio 0.95, 95% CI 0.92-0.98) and less craving (odds ratio 0.95, 95% CI 0.91-0.99), mainly between the ages of 15 and 17 years.

CONCLUSIONS

Religiosity provides some protection against drug consumption patterns in crack cocaine addicts.Declaration of interestNone.

Qualidade de Vida de cuidadores de praticantes de equoterapia no Distrito Federal

RESUMO O cuidador oferece atendimento individualizado, e a qualidade de sua atuação influencia na Qualidade de Vida (QV) da pessoa com deficiência. A sobrecarga de trabalho ou a falta de orientação quanto à melhor forma de sua atuação pode influenciar negativamente em sua saúde. Este artigo teve como objetivo avaliar a QV dos cuidadores dos praticantes de centros de equoterapia do Distrito Federal. Foi realizado um estudo de corte transversal em oito centros de equoterapia do Distrito Federal vinculados a Ande-Brasil, utilizando como instrumento de avaliação o questionário WHOQOL-bref para avaliar a QV dos cuidadores dos praticantes de equoterapia. Foram estudados 389 cuidadores, dos quais 71,72% correspondem ao gênero feminino e 28, 27% correspondem ao gênero masculino. Na análise dos resultados dos questionários, o domínio Relações Sociais obteve maior satisfação com escore de 66,13; o domínio Psicológico obteve escore de 64,52; o domínio Ambiente obteve escore de 60,8; e o domínio Físico apresentou o menor escore, obtendo 56,46. A média dos escores obtidos foi de 61,89. Os resultados demonstraram que a tarefa de cuidador pode provocar alterações físicas e mentais de forma negativa, e isso pode influenciar na qualidade de atendimento e no bem-estar do praticante.

Neuromuscular electrical stimulation for treating postpartum low back pain

In this retrospective study, we investigated the effect of neuromuscular electrical stimulation (NMES) in patients with postpartum low back pain (PPLBP).We included 67 patients with PPLBP in this study. All patients received NMES, each session 30 minutes, 1 session weekly for a total of 4 weeks. The primary outcome was measured by the reduction in pain intensity, based on the visual analogue scale (VAS). The secondary outcomes included functional status, measured by the Roland-Morris disability questionnaire (RMDQ), and quality of life, measured by the World Health Organization Quality of Life questionnaire (WHOQOL-BREF), as well as the adverse events related to the treatment. The outcome data were evaluated at baseline and at the end of 4-week treatment.After 4-week treatment, NMES did not exert better outcomes in pain relief, measured by VAS, and functional status, measured by RMDQ compared with those before the treatment. In addition, no significant improvement in quality of life, measured by WHOQOL-BREF, compared to it before the treatment.The results of our study did not find that NMES is effective in patients with PPLBP after 4-week treatment.

Psychometric properties of the EUROHIS-QOL 8-item index (WHOQOL-8) in a Brazilian sample

Objective:

To test the psychometric properties of the EUROHIS-QOL 8-item index in a Brazilian sample.

Methods:

The sample consisted of 151 patients and 174 healthy controls (n=325). Several psychometric properties were tested.

Results:

Reliability showed good internal consistency (Cronbach’s alpha = 0.81). The measure showed good discriminant validity between patients and healthy controls (mean1 = 3.32, SD1 = 0.70; mean2 = 3.77, SD2 = 0.63, t = 6.12, p < 0.001). Convergent validity showed significant correlations (p < 0.001) between the EUROHIS-QOL 8-item index and all domains of the WHOQOL-Bref (overall r = 0.47; general health r = 0.54; physical r = 0.69; psychological r = 0.62; social relationship r = 0.55; environment r = 0.55) and between the EUROHIS-QOL 8-item index and the domains of the SF-36, except for the social domain (p = 0.38). On Rasch analysis of unidimensionality, general fit measures showed adequate performance. The EUROHIS-QOL 8-item index also showed good fit on confirmatory factor analysis (CFA) (chi-square = 18.46, degrees of freedom [df] = 15; comparative fit index [CFI] = 0.99; root mean square error of approximation [RMSEA] = 0.03; goodness of fit index [gfi] = 0.99; root mean square residual [RMR] = 0.03; p = 24).

Conclusion:

The EUROHIS-QOL 8-item index showed good psychometric properties. It is a reliable quality of life measure that can be used in Brazilian populations.

Patient-Reported Quality of Life in the Highest Functioning Patients With Treacher Collins Syndrome

BACKGROUND

Treacher Collins syndrome has a wide variation of clinical presentation, including airway obstruction and hearing loss. The objective of this study was to assess patient-rated quality of life in Treacher Collins syndrome, who received multidisciplinary treatment at a specialized craniofacial hospital, and to compare their quality of life with a control sample.

METHODS

Treacher Collins patients under treatment in a multidisciplinary setting were assessed with the World Health Organization Quality of Life (WHOQOL-100) questionnaire. The Siviero scale was used to classify quality of life as unsatisfactory (scores below 25), intermediate (scores between 25 and 75), and satisfactory (scores above 75). Quality of life comparison between Treacher Collins patients and 2342 unaffected individuals from a previous database was performed using the analysis of variance test. Differences were considered significant at P < 0.05.

RESULTS

Treacher Collins patients demonstrated an overall intermediate and satisfactory (score >60%) quality of life in almost all WHOQOL-100 facets and domains. The comparison of the scores between unaffected individuals and Treacher Collins patients demonstrated a significant difference (P < 0.05) in the environment domain.

CONCLUSION

The highest functioning Treacher Collins syndrome patients under multidisciplinary treatment presented intermediate and satisfactory quality of life, consistent with quality of life scores of unaffected controls. In the environment domain, Treacher Collins patients presented even higher scores of quality of life than the control group.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Determinants of Health-Related and Oral Health–Related Quality of Life in Adults With Orofacial Clefts

Objectives:

To investigate the structural and intermediary determinants of health-related quality of life (HRQoL) and oral health–related quality of life (OHRQoL) among adults with cleft lip and/or palate (CL/P).

Design and Participants:

A cross-sectional study was conducted with patients enrolled at the referral center for craniofacial anomalies in Manaus, Brazil. Adults aged 18 years or more with nonsyndromic CL/P were selected.

Main Outcome Measures:

Both HRQoL and OHRQoL were assessed using the 36-item Short-Form Health Survey and the Oral Impacts on Daily Performance, respectively. Individual interviews and oral examinations were conducted to collect data on socioeconomic and demographic characteristics, social ties, health-related behaviors, compliance of CL/P protocol, chronic diseases, type of CL/P, oral clinical measures, and CL/P-related measures. Poisson regression was used to test the association of independent variables with HRQoL and OHRQoL outcomes.

Results:

The mean age of the 96 participants was 29.4 ± 9.1 years. Low family income, female sex, low social support, type of CL/P, and dental caries were associated with poor HRQoL and poor OHRQoL ( P < .05). Poor HRQoL was also associated with chronic diseases ( P < .05). Adults with low education, low social network, and smokers were more likely to have worse OHRQoL ( P < .05).

Conclusions:

Structural and intermediary determinants were related to HRQoL and OHRQoL in adults with CL/P, suggesting the need for interdisciplinary approaches to improve the management of CL/P and intersectoral actions to reduce the impact of social inequalities.

Spirituality, infertility-related stress, and quality of life in Brazilian infertile couples: Analysis using the actor-partner interdependence mediation model

Infertility has a stressful impact on both partners, with adverse effects on the quality of life of infertile couples. Spirituality is a meaning-based strategy that can protect couples against infertility's negative impact on quality of life, but analysis of this mediator relationship in infertile couples has not been reported. We adopted a dyadic approach and used the actor-partner interdependence mediation model to examine whether and how women's and men's spirituality was associated with their own and their partners' infertility-related stress and quality of life. In 2014, 152 infertile couples starting their first fertility treatment at a private clinic in Brazil were recruited and completed self-reports of spirituality, infertility-related stress, and quality of life. Results indicated that women's and men's level of spirituality was positively associated with their own quality of life directly and indirectly, by reducing their own infertility-related stress. Their spirituality was associated with an increase in their partners' quality of life only indirectly, by reducing their partners' infertility-related stress. Findings highlight the importance of assessing and promoting spirituality as a coping resource that infertile women and men might use to deal with the stress of infertility and reduce its adverse effects on quality of life.

Quality of life based on level of physical activity among elderly residents of urban and rural areas

Abstract Objective: To analyze quality of life (QOL) according to level of physical activity among elderly persons living in rural (RA) and urban (UA) areas. Method: A descriptive cross-sectional study, analyzing 358 elderly residents of RA and 139 of UA, in the municipal region of Palmas, Paraná, Brazil was performed. Quality of life, level of physical activity and economic condition were evaluated. For the analysis of the continuous variables, the student’s t-test or the Mann-Whitney test were used, based on the normality or otherwise of the data. Pearson's chi-squared or Fischer’s exact test were used to analyze the categorical variables. Results: The general perception of QOL reported in RA was better than in UA (p<0.05). The analysis of the level of physical activity according to place of residence showed that the elderly are more physically active in RA (p<0.05), whereas insufficiently active or sedentary subjects prevail in UA. The variables age and gender were not associated with QOL (p>0.05), irrespective of place of residence, and active elderly persons had better QOL scores than insufficiently active or sedentary individuals, again irrespective of place of residence (p<0.05). Conclusion: The present study provides evidence that QOL is positively influenced by both maintaining satisfactory levels of physical activity and by residing in RA. It is important to establish public policies aimed at ensuring a more active and independent old age, thus generating greater health and quality of life.

Is history of suicidal behavior related to social support and quality of life in outpatients with bipolar I disorder?

Bipolar disorder (BD) affects the social functioning and quality of life (QoL) of its patients. This study aimed to investigate whether there is an association between social support (SS), and suicidal behavior in BD I patients compared to healthy controls; secondarily, we evaluated the influence of QoL on those variables. A total of 119 euthymic outpatients with BD I, 46 of whom had attempted suicide (SAs) and 73 who had not (non-SAs), were compared to 63 healthy controls, through the Medical Outcomes Study Social Support Scale and World Health Organization's Quality of Life Instrument. No differences were noted in SS and QoL between SAs and non-SAs. Compared to healthy controls, non-SAs showed lower values in the positive social interaction domain of SS, and the patients, as a whole, showed lower values in affectionate and positive social interaction domains of SS. Compared to healthy controls, SAs had lower values in the environmental domain of QoL, and the patients, as a whole, had lower values in the environmental, social, and psychological domains of QoL. There was positive correlation between SS and QoL. Although BD is a disabling disease, patients receive inadequate SS. Interventions that may alter the SS in these patients should be investigated.

Risk factors and quality of life of dyslipidemic patients in Lebanon: A cross-sectional study

The main objective of this study was to identify the risk factors of dyslipidemia and measure its impact on patients' quality of life (QOL). Secondary objectives were to determine the percentage of dyslipidemia and assess the predictive factors affecting patients' QOL. A cross-sectional study was conducted in a sample of Lebanese population. A standardized questionnaire was developed to assess the QOL using the Short form-36 (SF-36) score. A total of 452 individuals were interviewed, of which 59.5% were females. The mean age was 43.3±15.6years, and 24.8% had dyslipidemia. The results show a lower overall QOL score among dyslipidemic patients compared with controls (57.9% and 76.5%, respectively; p<0.001). Waterpipe smoking [adjusted odds ratio (OR_a)=4.113, 95% confidence interval (CI): 1.696-9.971, p=0.002], hypertension (OR_a=3.597, 95% CI: 1.818-7.116, p<0.001), diabetes (OR_a=3.441, 95% CI: 1.587-7.462, p=0.002), cigarette smoking (OR_a=2.966, 95% CI: 1.516-5.804, p=0.001), and passive smoking (OR_a=2.716, 95% CI: 1.376-5.358, p=0.004) were significantly associated with dyslipidemia in individuals older than 30years. A higher overall QOL score (p=0.013) was observed in patients treated with statins in comparison with other lipid-lowering medications. In addition to clinical and economical consequences, dyslipidemia may have a significant impact on patients' QOL. Further research is needed to confirm the impact of treatment on dyslipidemic patients' QOL in order to maximize the overall benefits of therapy.

Impact of bariatric surgery on depression and anxiety symptons, bulimic behaviors and quality of life

OBJECTIVE

To assess psychiatric symptoms, substance use, quality of life and eating behavior of patients undergoing bariatric surgery before and after the procedure.

METHODS

We conducted a prospective longitudinal study of 32 women undergoing bariatric surgery. To obtain data, the patients answered specific, self-administered questionnaires.

RESULTS

We observed a reduction in depressive and anxious symptoms and also in bulimic behavior, as well as an improved quality of life in the physical, psychological and environmental domains. There was also a decrease in use of antidepressants and appetite suppressants, but the surgery was not a cessation factor in smoking and / or alcoholism.

CONCLUSION

a decrease in psychiatric symptoms was observed after bariatric surgery, as well as the reduction in the use of psychoactive substances. In addition, there was an improvement in quality of life after surgical treatment of obesity.

Quality of life in patients with oculocutaneous albinism

BACKGROUND

The social reality of the albino needs to be more studied in Brazil, as myths and social segregation regarding this illness are likely to be found in the country, with psychosocial and medical implications.

OBJECTIVE

As this subject has not been referenced in previous scientific articles in Brazil, this research intends to evaluate the quality of life of the albinos that treated at our medical institution.

METHODS

The quality of life was evaluated through the WHOQOL-BREF. Furthermore, two aspects of main relevance in the lives of the albinos were also objects of research, low vision and skin cancer. The sample consisted of forty oculocutaneous albinos and a control group of forty healthy individuals, matched by sex and age.

RESULTS

Among the participants, 57.7% were between 18 and 40 years old, 28.2% were between 41 and 60, and 14.1% were over 60. 42.1% had skin cancer before the study, 18.4% had skin cancer during the study and 89.5% stated visual deficit. The results obtained in the questionnaires showed a statistically significant difference in the physical domain, with P < 0.001.

CONCLUSION

Low vision combined with skin lesions and social stigma may contribute to disturbances in the quality of life of oculocutaneous albinos. The results presented in this study demonstrated the vulnerability of the affected individuals and the special care required by those patients, at the same time that the need for further research is highlighted in order to better elucidate the aspects related to albinism.

Quality of Life in Adults with Neurofibromatosis 1 in Brazil

Neurofibromatosis type 1 (NF1) is a neurocutaneous genetic disorder that can be associated with severe complications, and it may shorten patients' lifespan and affect their quality of life negatively. This study aimed to examine quality of life constructs among adults with NF1 in Brazil. It is an exploratory, descriptive and cross-sectional study consisting of two stages, involving thirteen adult patients with NF1. The first stage was developed using a quantitative methodology, namely the WHOQOL-100 questionnaire; responses for the 13 patients were compared to a matched control group. The second stage comprised clinical-qualitative research whereby participants took part in a semi-structured interview; these data were analyzed using the categorical thematic analysis technique. There were no statistically significant differences in the questionnaire domains between the NF1 patients and the control subjects. Eighteen main themes were extracted from the interviews, showing interference of the NF1 visibility principally in psychological aspects and social relationships. Patients mentioned curiosity about NF1 and confusion about the distinctions between NF1 and contagious diseases, which lead to prejudice. They were concerned about the future and how the disease would develop in themselves and their offspring, and emphasized difficulties acquiring proper healthcare. These findings may help in planning healthcare for Brazilian NF1 patients and improving their quality of life.

Psychometric characteristics of the Functional Assessment of Cancer Therapy-General when applied to Brazilian cancer patients: a cross-cultural adaptation and validation

BACKGROUND

The psychometric properties of an instrument should be evaluated routinely when using different samples. This study evaluated the psychometric properties of the Functional Assessment of Cancer Therapy-General (FACT-G) when applied to a sample of Brazilian cancer patients.

METHODS

The face, content, and construct (factorial, convergent, and discriminant) validities of the FACT-G were estimated. Confirmatory factor analysis (CFA) was conducted the ratio chi-square by degrees of freedom (χ (2)/df), the comparative fit index (CFI), the Tucker-Lewis index (TLI), and the root mean square error of approximation (RMSEA) as indices. The invariance of the best model was assessed with multi-group analysis using the difference of chi-squares method (Δχ(2)). Convergent validity was assessed using Average Variance Extracted (AVE) and discriminant validity was determined via correlational analysis. Internal consistency was assessed using the Cronbach's alpha (α) coefficient, and the Composite Reliability (CR) was estimated.

RESULTS

A total of 975 cancer patients participated in the study, with a mean age of 53.3 (SD = 13.0) years. Of these participants, 61.5 % were women. In CFA, five correlations between errors were included to fit the FACT-G to the sample (χ (2)/df = 8.611, CFI = .913, TLI = .902, RMSEA = .088). The model did not indicate invariant independent samples (Δχ(2): μ: p < .001, i: p < .958, Cov: p < .001, Res: p < .001). While there was adequate convergent validity for the physical well-being (AVE = .54) and social and family Well-being factors (AVE = .55), there was low convergent validity for the other factors. Reliability was adequate (CR = .76-.89 and α = .71-.82). Functional well-being, emotional well-being, and physical well-being were the factors that demonstrated a strong contribution to patients' health-related quality of life (β = -.99, .88, and .64, respectively).

CONCLUSION

The FACT-G was found to be a valid and reliable assessment of health-related quality of life in a Brazilian sample of patients with cancer.

A Follow-Up Study of 50 Chronic Hepatitis C Patients: Adiponectin as a Resilience Biomarker for Major Depression

OBJECTIVE

Major depression (MD) is a condition associated with both hepatitis C virus (HCV) infection and pegylated interferon (IFN)-α treatment. IFN induces a depressive syndrome that is associated with an inflammatory profile. We aimed to investigate whether there is any specific alteration in plasma biomarkers associated with MD.

METHODS

HCV-monoinfected patients, with and without IFN treatment, were followed up for 18 months and went through structured psychiatric evaluation. We assessed plasma levels of brain-derived neurotrophic factor, tumor necrosis factor (TNF) and its soluble type 1 and type 2 receptors (sTNFR1 and sTNFR2, respectively), and adipokines (adiponectin, leptin and resistin) using ELISA.

RESULTS

Among the 50 patients included in the study, 14 were treated with IFN during the follow-up. Being older, not married, presenting higher body mass index, higher liver inflammatory activity, lower baseline adiponectin levels and use of IFN were associated with MD development. Higher levels of sTNFR1 during IFN treatment were associated with sustained virological response. The lack of a control group without HCV infection did not allow any assumption of a biomarker change exclusively due to the infection itself.

CONCLUSION

Adiponectin may be a resilience biomarker for MD in HCV-infected patients.

Rationale and methods of a cluster-randomized controlled trial to promote active and healthy lifestyles among Brazilian students: the "Fortaleça sua Saúde" program

Background

Interventions on adolescents’ lifestyle are important, but the main mechanisms that explain the changes (mediating variables) on lifestyle are unclear. This paper presents the rationale and methods of an intervention program focused on promoting active and healthy lifestyles (especially physical activity [PA] practice and reducing screen time) among Brazilian students-the Fortaleça sua Saúde program (Portuguese for “strengthen your health”).

Methods/Design

This is a school-based cluster-randomized controlled trial. Three intervention and three control (no intervention) full-time public schools were randomly selected in Fortaleza, northeastern Brazil. Students (n = 1,272) from classes in Grades 7–9 were eligible, and 1,085 (548 in the intervention and 537 in control schools) completed the baseline and follow-up measures. The program duration was approximately four months and took place in 2014. Intervention strategies focused on teacher training, activities on health in the curriculum, active opportunities in the school environment (the availability of equipment for PA), and health education (health materials for students and parents). Data collection was undertaken before and immediately after the intervention. The primary variables included the practice of PA (weekly PA volume, PA behavior change stage and preference for PA during leisure-time) and screen time (TV and computer/video games). Potential intrapersonal, interpersonal and environmental mediators of PA and screen time were evaluated by a standardized questionnaire. Other lifestyle components (e.g., eating habits, substance use), psychological (e.g., self-rated health, body satisfaction) and biological (general and abdominal obesity) aspects, as well as academic performance were also evaluated in the total sample. Depressive symptoms, eating disorders, sleep quality, objectively-measured PA, and sedentary time were evaluated in obese students.

Discussion

If effective, this program will contribute to the development of public policies for the promotion of active and healthy lifestyles in youth, especially those from low- and middle-income countries. The main intrapersonal, interpersonal and/or environmental mediators of PA and screen time may also be indicated. Finally, we anticipate that the proposed strategies may be adaptable to public schools and may even be extended to the entire school system.

Trial registration

ClinicalTrials.Gov: NCT02439827. Registration date: May 3, 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2543-2) contains supplementary material, which is available to authorized users.

Intrinsic religiosity, resilience, quality of life, and suicide risk in depressed inpatients

BACKGROUND

Religiosity is inversely related to depression and is directly associated with positive psychological outcomes. Nonetheless, there is no consensus on whether or how religiosity could impact and protect against depression. The present study evaluated the association between intrinsic religiosity and resilient psychological characteristics in depressed inpatients.

METHODS

A sample of 143 depressed patients was prospectively evaluated in an inpatient psychiatric treatment in South Brazil. High Intrinsic Religiosity (HIR) and Low Intrinsic Religiosity (LIR) patients were compared across socio-demographic information, clinical measures, religiosity, resilience and quality of life. A linear regression model was used to evaluate the association between intrinsic religiosity and resilience, and the Cohen d test was utilized to assess effect sizes.

RESULTS

At admission, HIR patients showed higher HAM-D (p=0.05), BPRS (p=0.02), GAF (p=0.02), and CGI (p=0.03) scores, lower educational levels (p=0.04), higher social support (p=0.05), and fewer previous suicide attempts (p=0.05). At discharge, HIR patients showed higher quality of life (p=0.001) and higher resilience (p=0.000), with a large effect size difference between groups (1.02). Based on a linear regression model (adjusted r=0.19, p=0.000), intrinsic religiosity was associated with resilience, controlling for covariates.

CONCLUSION

In a sample of depressed inpatients, intrinsic religiosity was found to be associated with resilience, quality of life, and fewer previous suicide attempts. These findings support the relevance of religiosity assessments in mental health practice and support the hypothesis that resilient psychological characteristics may mediate the positive effects of intrinsic religiosity in depression.

Quality of life in a large cohort of adult Brazilian patients with 46,XX and 46,XY disorders of sex development from a single tertiary centre

OBJECTIVE

Few studies have focused on the quality of life (QoL) of patients with disorders of sex development (DSD). Our aim was to evaluate QoL in DSD patients with defined diagnoses followed until adulthood in a single tertiary centre.

PATIENTS AND METHODS

Adult patients with DSD (56 patients with 46,XX DSD - 49 with female social sex and 7 with male social sex as well as 88 patients with 46,XY DSD - 54 with female social sex and 34 with male social sex).

MEASUREMENTS

QoL using WHOQOL-Bref questionnaire.

RESULTS

Both patients with 46,XX DSD and patients with 46,XY DSD had similar QoL scores on the WHOQOL-Bref, comparable to the scores of the Brazilian general population. The chronological age at the start of treatment was negatively and significantly associated with general QoL score. Patients with male social sex DSD had better scores on the psychological domain than patients with female social sex DSD, as found in the Brazilian general population. In addition, among the 46,XY DSD group, the male social sex patients had better QoL compared with the female social sex patients. There was a positive and significant correlation between sexual performance and general QoL, although it explained only 4% of the variability of the general QoL score. The most influencing variables were general health, positive feelings and spirituality, religion and personal beliefs, each of them contributing with 18% of the variability of the general QoL score.

CONCLUSION

Our large cohort of adult patients with DSD, which was followed by a multidisciplinary team in a single tertiary centre, had good QoL in adulthood; in addition, late treatment compromised the QoL of patients with DSD, whereas sexual performance has little influence on QoL.

Spanish cross-cultural adaptation and psychometric properties of the Schizophrenia Quality of Life short-version questionnaire (SQoL18) in 3 middle-income countries: Bolivia, Chile and Peru

OBJECTIVE

The aim of this study was to adapt the Schizophrenia - Quality of Life short-version questionnaire (SQoL18) for use in three middle-income countries in Latin America and to evaluate the factor structure, reliability, and external validity of this questionnaire.

METHODS

The SQoL18 was translated into Spanish using a well-validated forward-backward process. We evaluated the psychometric properties of the SQoL18 in a sample of 253 patients with schizophrenia attending outpatient mental health services in three Latin American countries. For participants in each country (Bolivia, N=83; Chile, N=85; Peru, N=85), psychometric properties were compared to those reported from the reference population (507 patients with schizophrenia) assessed in the validation study. In addition, differential item functioning (DIF) analyses were performed to see whether all items behave in the same way in each country.

RESULTS

Factor analysis performed in the 3 countries showed that the questionnaire's structure adequately matched the initial structure of the SQoL18. The unidimensionality of the dimensions was preserved, and the internal/external validity indices were close to those of the reference population. However, one dimension of the SQoL18 (resilience) presented some unsatisfactory properties including low Cronbach's alpha coefficients, one INFIT value higher than 1.2, and one item showing DIF between the 3 countries.

CONCLUSIONS

These results demonstrate the satisfactory acceptability and psychometric properties of the SQoL18, suggesting the relevance of this questionnaire among patients with schizophrenia in these 3 Latin American countries.

[Quality of life of elementary education teachers in Florianópolis, State of Santa Catarina]

This study sought to investigate the perception of quality of life and the importance of the physical, psychological, social relationships and environmental domains for overall quality of life for elementary education teachers in Florianópolis in the State of Santa Catarina. The sample was composed of 349 teachers of the (state and municipal) public school system who filled out a questionnaire with socio-demographic information and the WHOQOL-BREF questionnaire. The average overall quality of life was 63.75 points. The environmental domain had the lowest average score (53.93 points) while the social relationship domain had the highest score (73.1 points). The environment and physical domains showed higher association with average overall quality of life. Teachers who worked in the state education system had the lowest average overall quality of life score (p = 0.001). Lowest scores for overall quality of life were linked to longer teaching hours (p = 0.008) and more weekly work hours (p = 0.013). Reduction of workload, health promotion programs during the career and ergonomic actions in the school environment are necessary.

[Influence of age on the perception of finitude and quality of life]

This cross-sectional study analyzed the influence of age on the perception of finitude and quality of life (QOL) of government employees, with a non-probabilistic accessibility sample composed of 471 employees with an average age of 40. A self-administered questionnaire was used for the study. The results show that physical activity of group C had the highest average in all components and group B the lowest values, with the exception of walking. All the participants achieved good scores in the four domains of QOL (58% - 74%). In the perception of finitude, group B obtained better scores (positive perception) in the four areas, whereas groups A and C had a more negative perception, there being no significant difference between the variables. This study reveals the positive relation of finitude in the age group from 35 to 50. Positive QOL and a high level of physical activity were identified.

Parry-Romberg syndrome: severity of the deformity does not correlate with quality of life

BACKGROUND

The aims of this study were to (1) describe the main clinical findings of Parry-Romberg syndrome (PRS), (2) evaluate surgical strategies and outcomes, and (3) investigate the quality of life of patients according to their disease severity.

METHODS

This retrospective observational study involved 14 patients treated between 2005 and 2011. The surgical treatment strategies were based on the proposed system for grading severity, and postoperative outcomes were assessed. The patients answered two questionnaires that covered the clinical manifestations of the syndrome and their quality of life in the postoperative period. A comparative analysis between the severity of the deformity and the quality of life was performed using the Kruskal-Wallis and Mann-Whitney tests.

RESULTS

The most prevalent clinical manifestation of PRS was progressive hemifacial atrophy (85.71 %). The surgical strategy was individualized based on the severity of disease of each patient. Surgical strategies included free-fat grafts, dermal fat grafts, and bone grafts associated with a temporoparietal fascia flap. Regardless of approach, all patients had an overall improvement in their facial appearance and were free of complications during the follow-up period. Our data showed no association between the severity of the deformity and the quality of life of these patients (all p > 0.05).

CONCLUSIONS

In this series, there was a predominance of clinical features of PRS that had been previously reported. Satisfactory outcomes were obtained using different surgical strategies that varied according to the severity of the deformity. The severity of the deformity did not impose a reduced quality of life on PRS patients.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Health related quality of life among patients with chronic hepatitis C: a cross-sectional study of sociodemographic, psychopathological and psychiatric determinants

Introduction

Chronic hepatitis C virus infection patients have higher rates of psychiatric disorders than the general population. Chronic hepatitis C virus infection is known to be associated with impaired health related quality of life. To our knowledge, there is no previous research of health related quality of life in chronic hepatitis C patients that combined structured psychiatric interview and careful psychopathological evaluation, including depression, anxiety and fatigue instruments. The aim of this study was to evaluate health related quality of life of chronic hepatitis C patients and to investigate the association with sociodemographic, psychopathological and psychiatric factors.

Materials and methods

Eighty-one individuals with chronic hepatitis C virus infection receiving care at a Brazilian public university-based outpatient service for infectious diseases were enrolled in the study. The World Health Organization Quality of Life Scale Brief Version was used to assess health related quality of life. Standard psychiatric interview (Mini International Neuropsychiatric Interview-Plus) was conducted to establish Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I psychiatric diagnosis. Further instruments completed psychopathological investigation: Beck Depression Inventory, Hospital Anxiety and Depression Scale, Brief Fatigue Inventory, Hamilton Depression Scale and Hamilton Anxiety Scale. Pearson Chi-Square and Kruskal–Wallis were performed for categorical and continuous univariate analysis, respectively. Correlation between psychopathological and health related quality of life scores was performed according to Spearman's correlation. Multivariate analysis was performed according to stepwise forward ordinal logistic regression. The significance threshold was fixed at α = 0.05.

Results

Depressive disorders were associated with worse scores in overall health related quality of life and in all domains. Fatigue was associated with lower scores in physical and psychological domains, and married status with higher scores in psychological health related quality of life. We found strong correlation among scores of depression, fatigue and health related quality of life.

Conclusion

Depression and fatigue must be properly investigated and managed in HCV patients in order to improve HRQL. WHOQOL-BREF proved to be a useful instrument to assess HRQL in HCV patients.

Instrumentos em Língua Brasileira de Sinais para avaliação da qualidade de vida da população surda

OBJETIVO: Construir a versão em Língua Brasileira de Sinais dos instrumentos WHOQOL-BREF e WHOQOL-DIS para avaliar a qualidade de vida da população surda brasileira.MÉTODOS: Utilizou-se metodologia proposta pela Organização Mundial da Saúde (WHOQOL-BREF e WHOQOL-DIS) para a construção dos instrumentos adaptados para população surda em Língua Brasileira de Sinais (Libras). A pesquisa para execução do instrumento consistiu de 13 etapas: 1) criação do sinal qualidade de vida; 2) desenvolvimento das escalas de respostas em Libras; 3) tradução por um grupo bilíngue; 4) versão reconciliadora; 5) primeira retrotradução; 6) produção da versão em Libras a ser disponibilizada aos grupos focais; 7) realização dos grupos focais; 8) revisão por um grupo monolíngue; 9) revisão pelo grupo bilíngue; 10) análise sintática/semântica e segunda retrotradução; 11) reavaliação da retrotradução pelo grupo bilíngue; 12) filmagem da versão para o software; 13) desenvolvimento do software WHOQOL-BREF e WHOQOL-DIS em Libras.RESULTADOS: Características peculiares da cultura da população surda apontaram a necessidade de adaptações na metodologia de aplicação de grupos focais quando compostos por pessoas surdas. As convenções ortográficas da escrita das línguas sinalizadas não estão consolidadas, o que trouxe dificuldades em registrar graficamente as etapas de tradução. As estruturas linguísticas que causaram maiores problemas de tradução foram as que incluíram expressões idiomáticas do português, muitas sem conceitos equivalentes entre o português e a Libras. Foi possível construir um software do WHOQOL-BREF e WHOQOL-DIS em Libras.CONCLUSÕES: O WHOQOL-BREF e o WHOQOL-DIS em Libras possibilitarão que os surdos se expressem autonomamente quanto a sua qualidade de vida, o que permitirá investigar com maior precisão essas questões.