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Borges RB, Caumo W, Bavaresco C, Stefani LPC, Santos VSD, Castro SMDJ. The brief measure of preoperative emotional stress screens preoperative maladaptive psychological features and predicts postoperative opioid use: an observational study. Braz J Anesthesiol 2024; 74:744425. [PMID: 36894010 DOI: 10.1016/j.bjane.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND The Brief Measure of Preoperative Emotional Stress (B-MEPS) is a suitable screening tool for Preoperative Emotional Stress (PES). However, personalized decision-making demands practical interpretation of the refined version of B-MEPS. Thus, we propose and validate cut-off points on the B-MEPS to classify PES. Also, we assessed if the cut-off points screened preoperative maladaptive psychological features and predicted postoperative opioid use. METHODS This observational study comprises samples of two other primary studies, with 1009 and 233 individuals, respectively. The latent class analysis derived emotional stress subgroups using B-MEPS items. We compared membership with the B-MEPS score through the Youden index. Concurrent criterion validity of the cut-off points was performed with the severity of preoperative depressive symptoms, pain catastrophizing, central sensitization, and sleep quality. Predictive criterion validity was performed with opioid use after surgery. RESULTS We chose a model with three classes labeled mild, moderate, and severe. The Youden index points -0.1663 and 0.7614 of the B-MEPS score classify individuals, in the severe class, with a sensitivity of 85.7% (80.1%-90.3%) and specificity of 93.5% (91.5-95.1%). The cut-off points of the B-MEPS score have satisfactory concurrent and predictive criterion validity. CONCLUSIONS These findings showed that the preoperative emotional stress index on the B-MEPS offers suitable sensitivity and specificity for discriminating the severity of preoperative psychological stress. They provide a simple tool to identify patients prone to severe PES related to maladaptive psychological features, which might influence the perception of pain and analgesic opioid use in the postoperative period.
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Affiliation(s)
- Rogério Boff Borges
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil; Hospital das Clínicas de Porto Alegre, Unidade de Bioestatística, Diretoria de Pesquisa, Porto Alegre, RS, Brazil.
| | - Wolnei Caumo
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Cirurgia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brazil; Hospital das Clínicas de Porto Alegre, Laboratório de Dor e Neuromodulação, Porto Alegre, RS, Brazil
| | - Caroline Bavaresco
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brazil
| | - Luciana Paula Cadore Stefani
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Cirurgia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brazil
| | | | - Stela Maris de Jezus Castro
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil; Hospital das Clínicas de Porto Alegre, Unidade de Bioestatística, Diretoria de Pesquisa, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Instituto de Matemática e Estatística, Departamento de Estatística, Porto Alegre, RS, Brazil
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Gadenz SD, Harzheim E, Rados DRV, Castro SMDJ, Drehmer M. Mobile Application Increased Nutrition Knowledge Among Brazilian Physicians. J Nutr Educ Behav 2024; 56:92-99. [PMID: 38127014 DOI: 10.1016/j.jneb.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 10/05/2023] [Accepted: 11/02/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To assess whether using a Dietary Approaches to Stop Hypertension (DASH) diet recommendation application increases primary care physicians' knowledge and dietary counseling skills. DESIGN A randomized controlled trial. SETTING Brazilian public primary care service. PARTICIPANTS Two hundred and twenty-two physicians (intervention group: n = 111; control group: n = 111). INTERVENTION Thirty days of using the Dieta Dash application. The application provides information about nutritional recommendations for hypertension management. MAIN OUTCOME MEASURES Nutrition knowledge score. SECONDARY OUTCOMES self-assessment of knowledge, self-confidence, assessment of eating habits, and barriers to dietary counseling. ANALYSIS Linear mixed-effects models for repeated measures and generalized estimating equations for comparing changes between groups. RESULTS A total of 66.2% of participants completed the follow-up. There was no significant difference between the groups regarding the mean knowledge score (P = 0.15). The prevalence of high knowledge increased by 12% (prevalence ratio [PR] = 1.12; 95% confidence interval [CI], 1.00-1.25) in the intervention group and showed an improvement in the self-confidence assessment (PR = 1.21; 95% CI, 1.02-1.44), and increased assessment of eating habits (PR = 1.26; 95% CI, 1.10-1.55). CONCLUSIONS AND IMPLICATIONS The Dieta Dash application helped address dietary counseling, improving knowledge and self-confidence. However, innovative strategies are needed to minimize the primary care barriers.
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Affiliation(s)
- Sabrina Dalbosco Gadenz
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Núcleo de Telessaúde of Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Erno Harzheim
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Stela Maris de Jezus Castro
- Department of Statistics, Institute of Mathematics and Statistics, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Michele Drehmer
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Department of Nutrition, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Scarpatto CH, Ley LLG, Ayala CO, Machado CR, Padoin AV, de Jezus Castro SM, Cañon-Montañez W, Mattiello R. Brazilian instrument for assessing of eating disorders in children and adolescents. Aten Primaria 2023; 55:102599. [PMID: 36905788 PMCID: PMC10023851 DOI: 10.1016/j.aprim.2023.102599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE This study aimed to develop the Brazilian instrument for assessing eating disorders in children and adolescents and test its psychometric quality using item response theory (IRT). DESIGN Cross-sectional study. PARTICIPANTS Participants aged between five and twelve years old of both sexes. MAIN MEASURES IRT logistic model of two parameters was used to evaluate the item's severity and discrimination and test information curve of symptoms of eating disorders' latent trait symptoms. Content validity and reliability were also assessed. The IRT evaluation suggested that the instrument contained items that performed differently concerning severity, discrimination, and test information curve presented good accuracy. RESULTS There was agreement on the clarity of language (83.3%) and theoretical relevance (91.7%), indicating good content validity. The value of the Cronbach's Alpha was 0.63 (95% confidence interval), and the result of the Spearman-Brown test was 0.65. CONCLUSION These results indicate good performance of the screening tool in assessing the level of eating disorders in children and adolescents.
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Affiliation(s)
- Camila H Scarpatto
- School of Medicine, Postgraduate Program in Pediatrics and Child Health and Postgraduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica de Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Laura L G Ley
- School of Medicine, Postgraduate Program in Pediatrics and Child Health, Pontifícia Universidade Católica de Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Camila O Ayala
- School of Medicine, Postgraduate Program in Pediatrics and Child Health, Pontifícia Universidade Católica de Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Cátia Regina Machado
- School of Health and Life Sciences, Pontifícia Universidade Católica de Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Alexandre Vontobel Padoin
- School of Medicine, Postgraduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica de Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | | | | | - Rita Mattiello
- School of Medicine, Postgraduate Program in Epidemiology, Universidade Federal de Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Paiz JC, de Jezus Castro SM, Giugliani ERJ, Dos Santos Ahne SM, Aqua CBD, Giugliani C. Association between mistreatment of women during childbirth and symptoms suggestive of postpartum depression. BMC Pregnancy Childbirth 2022; 22:664. [PMID: 36028806 PMCID: PMC9413948 DOI: 10.1186/s12884-022-04978-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Postpartum depression is a common condition in the pregnancy and postpartum cycle. The development of this condition is multifactorial and can be influenced by previous traumas. This study sought to verify whether there is an association between having been exposed to mistreatment during childbirth and presenting symptoms suggestive of postpartum depression. Methods This is a cross-sectional study, with the inclusion of 287 women without complications in childbirth, randomly selected from two maternity hospitals of Porto Alegre, southern Brazil, in 2016. Four weeks after delivery, the postpartum women answered a face-to-face interview about socioeconomic aspects, obstetric history, health history, and childbirth experience (practices and interventions applied) and completed the Edinburgh Postnatal Depression Scale (EPDS). From the perception of women regarding the practices performed in the context of childbirth care, a composite variable was created, using item response theory, to measure the level of mistreatment during childbirth. The items that made up this variable were: absence of a companion during delivery, feeling insecure and not welcome, lack of privacy, lack of skin-to-skin contact after delivery, not having understood the information shared with them, and not having felt comfortable to ask questions and make decisions about their care. To define symptoms suggestive of postpartum depression, reflecting on increased probability of this condition, the EPDS score was set at ≥ 8. Poisson Regression with robust variance estimation was used for modeling. Results Women who experienced mistreatment during childbirth had a higher prevalence of symptoms suggestive of postpartum depression (PR 1.55 95% CI 1.07–2.25), as well as those with a history of mental health problems (PR 1.69 95% CI 1.16–2.47), while higher socioeconomic status (A and B) had an inverse association (PR 0.53 95% CI 0.33–0.83). Conclusions Symptoms suggestive of postpartum depression seem to be more prevalent in women who have suffered mistreatment during childbirth, of low socioeconomic status, and with a history of mental health problems. Thus, qualifying care for women during pregnancy, childbirth and postpartum and reducing social inequalities are challenges to be faced in order to eliminate mistreatment during childbirth and reduce the occurrence of postpartum depression.
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Affiliation(s)
- Janini Cristina Paiz
- Graduate Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400 - Santa Cecília, Porto Alegre, RS, Brazil.
| | - Stela Maris de Jezus Castro
- Graduate Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400 - Santa Cecília, Porto Alegre, RS, Brazil.,Department of Statistics, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400 - Santa Cecília, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Elsa Regina Justo Giugliani
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Child and Adolescent Health, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400 - Santa Cecília, Porto Alegre, RS, Brazil
| | - Sarah Maria Dos Santos Ahne
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400 - Santa Cecília, Porto Alegre, RS, Brazil
| | - Camila Bonalume Dall' Aqua
- Graduate Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400 - Santa Cecília, Porto Alegre, RS, Brazil
| | - Camila Giugliani
- Graduate Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400 - Santa Cecília, Porto Alegre, RS, Brazil
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Paiz JC, de Jezus Castro SM, Giugliani ERJ, dos Santos Ahne SM, Aqua CBD, Souto AS, Giugliani C. Development of an instrument to measure mistreatment of women during childbirth through item response theory. PLoS One 2022; 17:e0271278. [PMID: 35819960 PMCID: PMC9275678 DOI: 10.1371/journal.pone.0271278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
The objective of this study was to structure a proposal for an instrument to measure the mistreatment level of women during childbirth, through item response theory, based on the birth experience of postpartum women. A cross-sectional study was conducted, with the inclusion of 287 women who did not suffer complications during childbirth, randomly selected from two maternity hospitals in the capital of Rio Grande do Sul—Brazil, in 2016. Approximately 30 days after delivery, the women answered questions in a face-to-face interview about their birth experience (practices and interventions applied) and were inquired about their perception of having suffered disrespect, mistreatment or humiliation by health professionals. The set of practices was included in the item response theory model to design the instrument. Of the 36 items included in the model, 21 dealt with practices applied exclusively to women who went into labor, therefore two instruments were developed. The instrument including all women, containing 09 items, identified 23.7% prevalence of mistreatment to women during childbirth, while the instrument for women going into labor included 11 items and identified 22% prevalence. The items with the highest discrimination were: not having had a companion during labor (2.05; and 1.26), not feeling welcome (1.81; and 1.58), and not feeling safe (1.59; and 1.70), for all women and for those who went into labor, respectively. For those who went into labor, the items, did not have a companion during labor (1.22; PE 0.88) and did not feel comfortable asking questions and participating in decisions (1.20; PE 0.43) also showed greater discrimination. In contrast, when directly questioned, only 12.5% of women said they had experienced disrespect or mistreatment, suggesting that harmful practices are often not recognized as violent. Standardizing the measurement of mistreatment of women during childbirth can create more accurate estimates of its prevalence and contribute to the proposal of strategies to eliminate obstetric violence.
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Affiliation(s)
- Janini Cristina Paiz
- Graduate Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- * E-mail:
| | - Stela Maris de Jezus Castro
- Graduate Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Department of Statistics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Elsa Regina Justo Giugliani
- Graduate Program in Child and Adolescent Health, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | - Camila Bonalume Dall’ Aqua
- Graduate Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Alice Steglich Souto
- Graduate Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Camila Giugliani
- Graduate Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Maciel-Fiuza MF, Costa PDSS, Kowalski TW, Schuler-Faccini L, Bonamigo RR, Vetoratto R, Eidt LM, de Moraes PC, Silveira MIDS, Camargo LMA, Callegari-Jacques SM, Castro SMDJ, Vianna FSL. Evaluation of Polymorphisms in Toll-Like Receptor Genes as Biomarkers of the Response to Treatment of Erythema Nodosum Leprosum. Front Med (Lausanne) 2022; 8:713143. [PMID: 35141236 PMCID: PMC8819000 DOI: 10.3389/fmed.2021.713143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/09/2021] [Indexed: 01/18/2023] Open
Abstract
Erythema nodosum leprosum (ENL) is an inflammatory complication caused by a dysregulated immune response to Mycobacterium leprae. Some Toll-like receptors (TLRs) have been identified as capable of recognizing antigens from M. leprae, triggering a wide antimicrobial and inflammatory response. Genetic polymorphisms in these receptors could influence in the appearance of ENL as well as in its treatment. Thus, the objective of this work was to evaluate the association of genetic variants of TLRs genes with the response to treatment of ENL with thalidomide and prednisone. A total of 162 ENL patients were recruited from different regions of Brazil and clinical information was collected from their medical records. Genomic DNA was isolated from blood and saliva samples and genetic variants in TLR1 (rs4833095), TLR2 (rs3804099), TLR4 (rs1927914), and TLR6 (rs5743810) genes were genotyped by TaqMan real-time PCR system. In order to evaluate the variants' association with the dose of the medications used during the treatment, we applied the Generalized Estimating Equations (GEE) analysis. In the present sample, 123 (75.9%) patients were men and 86 (53.1%) were in treatment for leprosy during the ENL episode. We found an association between polymorphisms in TLR1/rs4833095, TLR2/rs3804099, TLR4/rs1927914, and TLR6/rs5783810 with the dose variation of thalidomide in a time-dependent manner, i.e., the association with the genetic variant and the dose of the drug was different depending on the moment of the treatment evaluated. In addition, we identified that the association of polymorphisms in TLR1/rs4833095, TLR2/rs3804099, and TLR6/rs5783810 with the dose variation of prednisone also were time-dependent. Despite these associations, in all the interactions found, the influence of genetic variants on dose variation was not clinically relevant for therapeutic changes. The results obtained in this study show that TLRs polymorphism might play a role in the response to ENL treatment, however, in this context, they could not be considered as useful biomarkers in the clinical setting due small differences in medication doses. A larger sample size with patients with a more genetic profile is fundamental in order to estimate the association of genetic variants with the treatment of ENL and their clinical significance.
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Affiliation(s)
- Miriãn Ferrão Maciel-Fiuza
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Instituto Nacional de Genética Médica Populacional, Porto Alegre, Brazil
- Genomics Medicine Laboratory, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Laboratory of Immunobiology and Immunogenetics, Postgraduate Program in Genetics and Molecular Biology, Department of Genetics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | | | - Thayne Woycinck Kowalski
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Instituto Nacional de Genética Médica Populacional, Porto Alegre, Brazil
- Genomics Medicine Laboratory, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Laboratory of Immunobiology and Immunogenetics, Postgraduate Program in Genetics and Molecular Biology, Department of Genetics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Lavínia Schuler-Faccini
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Instituto Nacional de Genética Médica Populacional, Porto Alegre, Brazil
- Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Renan Rangel Bonamigo
- Post-graduate Program in Pathology, Universidade Federal De Ciências Da Saúde de Porto Alegre, Porto Alegre, Brazil
- Dermatology Service of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Medicine, Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Rodrigo Vetoratto
- Dermatology Service of Santa Casa Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Letícia Maria Eidt
- Sanitary Dermatology Clinic, Secretaria De Saúde Do Estado Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Paulo Cezar de Moraes
- Postgraduate Program in Medicine, Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Sanitary Dermatology Clinic, Secretaria De Saúde Do Estado Do Rio Grande Do Sul, Porto Alegre, Brazil
| | | | - Luis Marcelo Aranha Camargo
- National Reference Center for Health Dermatology Dona Libania, Fortaleza, Brazil
- Center for Research in Tropical Medicine, Porto Velho, Rondonia, Brazil
- National Institute of Science and Technology-EpiAmo, Rondonia, Brazil
- Department of Medicine, Centro Universitario São Lucas, Porto Velho, Rondônia, Brazil
- National Institute of Science and Technology/CNPq-EpiAmo, Rondonia, Brazil
| | - Sidia Maria Callegari-Jacques
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Postgraduate Program in Medicine, Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Department of Statistics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Stela Maris de Jezus Castro
- Department of Statistics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Postgraduate Program in Epidemiology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Fernanda Sales Luiz Vianna
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Instituto Nacional de Genética Médica Populacional, Porto Alegre, Brazil
- Genomics Medicine Laboratory, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Laboratory of Immunobiology and Immunogenetics, Postgraduate Program in Genetics and Molecular Biology, Department of Genetics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Postgraduate Program in Medicine, Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
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Preto LT, Scarpatto CH, Ley LLG, Silveira C, Salerno MR, Moreno JP, Castro SMDJ, Booij L, Mattiello R. Validation of the Family Health Behavior Scale for the Brazilian population. J Pediatr (Rio J) 2022; 98:84-91. [PMID: 33965407 PMCID: PMC9432311 DOI: 10.1016/j.jped.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To validate the Family Health Behavior Scale (FHBS) for Brazilian families. METHODS The sample included 272 children aged 5 to 12 years old. Caregivers and their healthy answered the FHBS and questions about physical activity. In addition, anthropometric measurements of the children's weight and height were performed, as well as the bioimpedance exam. The scale was translated and the following validities were assessed: content (qualitative analysis and content validity index), construct (factor analysis) and concurrent validity (difference between domains and the total score with the categories of BMI, fat percentage and physical activity). Reliability (Cronbach's alpha, ceiling-floor effect, two-half test, intraclass correlation and Bland - Altman) was also assessed. RESULTS FHBS instrument performed well with regard to the psychometric properties in the Brazilian population. The content validity index was 0.987. Fit indices of the factor analysis were considered satisfactory, according to Bartlett's sphericity test (χ 2 = 1927, df = 351; p < 0.001) and the Kaiser-Meyer-Olkin index (KMO = 0.789). Concurrent validity, the differences between the mean of the domains and the total score between the categories of BMI (p = 0.011), percentage of fat (0.004) and physical activity (p < 0.001) were all significant. The reliability results were Cronbach's alpha internal consistency = 0.83, adequate ceiling-floor effect, 0.8105 (0.09 SD) two-half test, 0.626 intraclass correlation (95% CI: 0.406 to 0.777) and Bland - Altman -0.840 (-22.76 to 21.07). CONCLUSION The FHBS adapted for the Brazilian population showed evidence of adequate psychometric performance.
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Affiliation(s)
- Luiza Tweedie Preto
- Pontifícia Universidade Católica do Rio Grande do Sul, Programa de Pós-graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Camila H Scarpatto
- Pontifícia Universidade Católica do Rio Grande do Sul, Programa de Pós-graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Laura Lessa Gaudie Ley
- Pontifícia Universidade Católica do Rio Grande do Sul, Programa de Pós-graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Carolina Silveira
- Pontifícia Universidade Católica do Rio Grande do Sul, Programa de Pós-graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Faculdade de Nutrição, Porto Alegre, RS, Brazil
| | - Margareth Rodrigues Salerno
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina, Núcleo de Formação em Pediatria e Saúde da Família, Porto Alegre, RS, Brazil
| | - Jennette Palcic Moreno
- Baylor College of Medicine, Houston, USDA/ARS Children's Nutrition Research Center, Department of Pediatrics-Nutrition, Houston, Texas
| | | | - Linda Booij
- University of Montreal, Concordia University & CHU Sainte-Justine, Department of Psychology, Montreal, Canada
| | - Rita Mattiello
- Pontifícia Universidade Católica do Rio Grande do Sul, Programa de Pós-graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Programa de Pós-graduação em Medicina e Ciências da Saúde, Porto Alegre, RS, Brazil.
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de Souza Gutierrez C, Bottega K, de Jezus Castro SM, Gravina GL, Toralles EK, Silveira Martins OR, Caumo W, Stefani LC. The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients. PLoS One 2021; 16:e0257941. [PMID: 34780486 PMCID: PMC8592468 DOI: 10.1371/journal.pone.0257941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 09/14/2021] [Indexed: 11/19/2022] Open
Abstract
Background Practical use of risk predictive tools and the assessment of their impact on outcome reduction is still a challenge. This pragmatic study of quality improvement (QI) describes the preoperative adoption of a customised postoperative death probability model (SAMPE model) and the evaluation of the impact of a Postoperative Anaesthetic Care Unit (PACU) pathway on the clinical deterioration of high-risk surgical patients. Methods A prospective cohort of 2,533 surgical patients compared with 2,820 historical controls after the adoption of a quality improvement (QI) intervention. We carried out quick postoperative high-risk pathways at PACU when the probability of postoperative death exceeded 5%. As outcome measures, we used the number of rapid response team (RRT) calls within 7 and 30 postoperative days, in-hospital mortality, and non-planned Intensive Care Unit (ICU) admission. Results Not only did the QI succeed in the implementation of a customised risk stratification model, but it also diminished the postoperative deterioration evaluated by RRT calls on very high-risk patients within 30 postoperative days (from 23% before to 14% after the intervention, p = 0.05). We achieved no survival benefits or reduction of non-planned ICU. The small group of high-risk patients (13% of the total) accounted for the highest proportion of RRT calls and postoperative death. Conclusion Employing a risk predictive tool to guide immediate postoperative care may influence postoperative deterioration. It encouraged the design of pragmatic trials focused on feasible, low-technology, and long-term interventions that can be adapted to diverse health systems, especially those that demand more accurate decision making and ask for full engagement in the control of postoperative morbi-mortality.
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Affiliation(s)
- Claudia de Souza Gutierrez
- Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Anaesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Katia Bottega
- Anaesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Gabriela Leal Gravina
- Anaesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Eduardo Kohls Toralles
- Anaesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Wolnei Caumo
- Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Surgery, School of Medicine, UFRGS, Porto Alegre, Brazil
- Laboratory of Pain & Neuromodulation, School of Medicine, UFRGS, Porto Alegre, Brazil
| | - Luciana Cadore Stefani
- Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Anaesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Department of Surgery, School of Medicine, UFRGS, Porto Alegre, Brazil
- * E-mail:
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Neves Smiderle FR, Ramos-Silva V, Castro SMDJ, Courvoisier DS, Mattiello R. Portuguese validation of the Regret Intensity Scale (RIS-10) for measuring the intensity of regret associated with the provision of attention in health. Invest Educ Enferm 2021; 39:e09. [PMID: 34822236 PMCID: PMC8912158 DOI: 10.17533/udea.iee.v39n3e09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The aim of the study was to adapt and validate the Regret Intensity Scale-10 (RIS-10) for Brazilian health professionals. METHODS The validation study took place in two phases, in which the first was the translation of the instruments and the second, the field validation using psychometric properties validity and reliability of the scale with 341 professionals (doctors, nurses and physiotherapists) linked to hospitals. Validity was assessed using content validities (six judges evaluation), criteria (correlation with the Life Satisfaction Scale - SWLS and Self-Reporting Questionnaire 20 -SRQ-20) and construct (exploratory analysis using the rotation method Promax, based on the slope graph and the Kaiser criterion and confirmatory using the structural equation model) after applying the questionnaire to professionals.Reliability was measured by Cronbach's α coefficient and retest test over a maximum period of 30 days. Reproducibility was calculated by intraclass correlation. RESULTS A total of 341 professionals participated, with an average age of 38.6 ± 9.2 years. The content validity index (CVI) was 1.00, for all items of the scale in the proportion of agreement of the judges. Exploratory factor analysis showed a satisfactory correlation (Kaiser-Meyer-Olkin = 0.88), suggesting a two-factor model, which comprises the main components of the emotion of regret (Factor I - emoticons, Factor II - feelings), accounting for 64% of the total variation of the first factor. In the confirmation, the index standardized root mean squared residual = 0.063 was close to the acceptable and other values were below. The scale correlated positively with SRQ-20 (p < 0.001) and negatively with SLWS (p = 0.003). Reliability showed (Cronbach's α = 0.863) and test-retest reliability showed lower values than expected. The Bland-Altman graph showed a mean bias of -1.5 with lower and upper limits of 15.8 to 12.8 respectively. CONCLUSIONS The RIS-10 adapted for the population performed adequately in the psychometric properties evaluated for the assessment of the intensity of regret related to the provision of health care.
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Affiliation(s)
- Fabiana Rosa Neves Smiderle
- Enfermeira. Doutora. Professora da Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, EMESCAM, Espírito Santo, Brazil. Escola Superior de Ciências da Santa Casa de Misericórdia de VitóriaEspírito SantoBrazil
| | - Valmin Ramos-Silva
- Médico. Doutor. Professora. Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, EMESCAM, Espírito Santo, Brazil. Escola Superior de Ciências da Santa Casa de Misericórdia de VitóriaEscola Superior de Ciências da Santa Casa de Misericórdia de VitóriaEspírito SantoBrazil
| | - Stela Maris de Jezus Castro
- Estatística. Doutora. Professora Universidade Federal do Rio Grande do Sul, Brazil. Universidade Federal do Rio Grande do SulUniversidade Federal do Rio Grande do SulBrazil
| | - Delphine Sophie Courvoisier
- Bioestatística. Doutora. Professora Hôpitaux Universitaires de Genève, Swiss. Hôpitaux Universitaires de GenèveSwiss
| | - Rita Mattiello
- Fisioterapeuta. Doutora. Professora Pontifícia Universidade Católica, Porto Alegre, Rio Grande do Sul, Brazil. . Corresponding authorPontifícia Universidade CatólicaPorto AlegreRio Grande do SulBrazil
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Passos SC, Stahlschmidt A, Blanco J, Spader ML, Brandão RB, Castro SMDJ, Gutierrez CDS, Silva Neto PCD, Stefani LPC. Derivation and validation of a national multicenter mortality risk stratification model - the ExCare model: a study protocol. Braz J Anesthesiol 2021; 72:316-321. [PMID: 34324938 PMCID: PMC9373516 DOI: 10.1016/j.bjane.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/21/2021] [Accepted: 07/03/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Surgical care is essential for proper management of various diseases. However, it can result in unfavorable outcomes. In order to identify patients at higher risk of complications, several risk stratification models have been developed. Ideally, these tools should be simple, reproducible, accurate, and externally validated. Unfortunately, none of the best-known risk stratification instruments have been validated in Brazil. In this sense, the Ex-Care model was developed by retrospective data analysis of surgical patients in a major Brazilian university hospital. It consists of four independent predictors easily collected in the preoperative evaluation, showing high accuracy in predicting death within 30 days after surgery. Objectives To update and validate a Brazilian national-based model of postoperative death probability within 30 days based on the Ex-Care model. Also, to develop an application for smartphones that allows preoperative risk stratification by Ex-Care model. Methods Ten participating centers will collect retrospective data from digital databases. Variables age, American Society of Anesthesiologists (ASA) physical status, surgical severity (major or non-major) and nature (elective or urgent) will be evaluated as predictors for in-hospital mortality within 30 postoperative days, considered the primary outcome. Expected results We believe that the Ex-Care model will present discriminative capacity similar to other classically used scores validated for surgical mortality prediction. Furthermore, the mobile application to be developed will provide a practical and easy-to-use tool to the professionals enrolled in perioperative care.
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Affiliation(s)
- Sávio Cavalcante Passos
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Adriene Stahlschmidt
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - João Blanco
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Schneider L, Castro SMDJ, Mallman ES, Evaldt CDA, Souza A, Rodrigues JDS, Mendanha C, Caumo W, Stefani LC. Validation of the Brazilian version of the child pain catastrophizing scale and its relationship with a marker of central sensitization. Braz J Anesthesiol 2021; 72:614-621. [PMID: 33932395 PMCID: PMC9515684 DOI: 10.1016/j.bjane.2021.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 02/20/2021] [Accepted: 02/27/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives The Pain Catastrophizing Scale-Child version (PCS-C) allows to identify children who are prone to catastrophic thinking. We aimed to adapt the Brazilian version of PCS-C (BPCS-C) to examine scale psychometric properties and factorial structure in children with and without chronic pain. Also, we assessed its correlation with salivary levels of Brain-Derived Neurotrophic factor (BDNF). Methods The Brazilian version of PCS-C was modified to adjust it for 7–12 years old children. To assess psychometric properties, 100 children (44 with chronic pain from a tertiary hospital and 56 healthy children from a public school) answered the BPCS-C, the visual analogue pain scale, and questions about pain interference in daily activities. We also collected a salivary sample to measure BDNF. Results We observed good internal consistency (Cronbach’s value = 0.81). Parallel analysis retained 2 factors. Confirmatory factor analysis of our 2-factor model revealed consistent goodness-of-fit (IFI = 0.946) when compared to other models. There was no correlation between visual analogue pain scale and the total BPCS-C score; however, there was an association between pain catastrophizing and difficulty in doing physical activities in school (p = 0.01). BPCS-C total scores were not different between groups. We found a marginal association with BPCS-C (r = 0.27, p = 0.01) and salivary BDNF levels. Discussion BPCS-C is a valid instrument with consistent psychometric properties. The revised 2-dimension proposed can be used for this population. Children catastrophism is well correlated with physical limitation, but the absence of BPCS-C score differences between groups highlights the necessity of a better understanding about catastrophic thinking in children.
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Affiliation(s)
- Larissa Schneider
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-graduação em Ciências Médicas, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Laboratório de Dor e Neuromodulação, Porto Alegre, RS, Brazil
| | | | - Eliza Saggin Mallman
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil
| | - Cibelle de Abreu Evaldt
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil
| | - Andressa Souza
- Hospital de Clínicas de Porto Alegre (HCPA), Laboratório de Dor e Neuromodulação, Porto Alegre, RS, Brazil
| | - Josy da Silva Rodrigues
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Clarissa Mendanha
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil
| | - Wolnei Caumo
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Laboratório de Dor e Neuromodulação, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Departamento de Cirurgia, Porto Alegre, RS, Brazil
| | - Luciana Cadore Stefani
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Laboratório de Dor e Neuromodulação, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Departamento de Cirurgia, Porto Alegre, RS, Brazil.
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12
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Wolmeister AS, Schiavo CL, Nazário KCK, Castro SMDJ, de Souza A, Caetani RP, Caumo W, Stefani LC. The Brief Measure of Emotional Preoperative Stress (B-MEPS) as a new predictive tool for postoperative pain: A prospective observational cohort study. PLoS One 2020; 15:e0227441. [PMID: 31914146 PMCID: PMC6948814 DOI: 10.1371/journal.pone.0227441] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/18/2019] [Indexed: 01/01/2023] Open
Abstract
Background Preoperative patients’ vulnerabilities such as physical, social, and psychological are implicated in postoperative pain variability. Nevertheless, it is a challenge to analyze a patient's psychological profile in the preoperative period in a practical and consistent way. Thus, we sought to identify if high preoperative emotional stress, evaluated by the Brief Measure of Emotional Preoperative Stress (B-MEPS) scale is associated with higher postoperative pain levels and poor rehabilitation in patients submitted to intermediate or major surgery. Moreover, the possible neurobiological or neurophysiological mechanisms implicated in high preoperative emotional stress, evaluated through preoperative quantitative sensory pain tests and serum biomarkers BDNF and S100B were investigated. Methods We conducted a prospective, observational, cohort study of ASA 2 and 3 adult patients undergoing major urologic, gynecologic, proctologic and orthopedic surgeries from March 2017 to March 2018. B-MEPS and Central Sensitivity Inventory were evaluated preoperatively, followed by a sequence of experimental pain tests and serum biomarkers collection. Postoperative evaluation carried out within the first 48 hours after surgery comprehended pain at rest and movement-evoked pain, and the consumption of morphine. Quality-of-Recovery was also evaluated in the 3rd postoperative day. Results 23 (15%) out of 150 patients included in the study presented high emotional preoperative stress. Variables significantly related to preoperative stress were: previous psychiatric diagnosis and Central Sensitization Inventory result. Mean movement-evoked pain in the first 12 to 48 hours was 95–105% higher than pain at rest. A mixed model for repeated measures showed a sustainable effect of B-MEPS as a movement-evoked pain predictor. Previous pain, cancer surgery, and preoperative pressure pain tolerance were also independent predictors of postoperative pain. Moderate to severe postoperative movement-evoked pain was predictive of poor rehabilitation in 48 hours after surgery. Conclusion We confirmed that a brief screening method of preoperative emotional states could detect individuals prone to experience severe postoperative pain. Specific interventions considering the stress level may be planned in the future to improve perioperative outcomes.
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Affiliation(s)
- Anelise Schifino Wolmeister
- Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Pain & Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Carolina Lourenzon Schiavo
- Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Kahio César Kuntz Nazário
- Anaesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Andressa de Souza
- Laboratory of Pain & Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Rafael Poli Caetani
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Wolnei Caumo
- Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Luciana Cadore Stefani
- Laboratory of Pain & Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Anaesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- * E-mail:
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Bizon AMBL, Giugliani C, Castro de Avilla Lago J, de Senna AFK, Martins ACM, de Jezus Castro SM, Giugliani ERJ. Combined pro-breastfeeding practices are advantageous in facilities providing maternity and newborn services. Matern Child Nutr 2019; 15:e12822. [PMID: 30950212 DOI: 10.1111/mcn.12822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 01/01/2023]
Abstract
This study aimed to evaluate the association between a set of pro-breastfeeding practices in facilities providing maternity and newborn services and the prevalence of exclusive breastfeeding at 30 days postpartum, considering the contribution of each practice. A cross-sectional study nested within a cohort study was conducted with 287 women who delivered healthy term infants in two hospitals in southern Brazil. They were interviewed at home at 30 days postpartum. The following practices were evaluated: skin-to-skin contact soon after birth, breastfeeding in the first hour, uninterrupted rooming-in, professional support with breastfeeding, breastfeeding guidance, encouragement to breastfeed on demand, no supplementation with infant formula, and no pacifier use. A score of pro-breastfeeding practices was calculated using a logistic model, which allowed each practice to have its discriminatory capacity and difficulty estimated individually. Poisson regression was used to estimate the association between exclusive breastfeeding at 30 days and the pro-breastfeeding practice score. The prevalence of exclusive breastfeeding at 30 days was 61.7%. The practices with greatest discriminatory capacity, that is, those that contributed most to the score estimates, were professional support with breastfeeding, breastfeeding guidance, and encouragement to breastfeed on demand. The most difficult ones were breastfeeding in the first hour, encouragement to breastfeed on demand, and non-utilization of infant formula. For each unit (standard deviation) of increase in the score, there was an increase of 20% in the prevalence of exclusive breastfeeding at 30 days. We conclude that the set of pro-breastfeeding practices assessed here increased the effect of these practices on exclusive breastfeeding rates at 30 days.
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Affiliation(s)
- Agnes Meire Branco Leria Bizon
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Camila Giugliani
- Department of Social Medicine and Graduate Program in Epidemiology, UFRGS, Porto Alegre, Brazil
| | - Juliana Castro de Avilla Lago
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Andrea Francis Kroll de Senna
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | | | - Elsa Regina Justo Giugliani
- Department of Pediatrics and Graduate Program in Child and Adolescent Health, School of Medicine, UFRGS, Porto Alegre, Brazil
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Seganfredo DH, Beltrão BA, Silva VMD, Lopes MVDO, Castro SMDJ, Almeida MDA. Analysis of ineffective breathing pattern and impaired spontaneous ventilation of adults with oxygen therapy. Rev Lat Am Enfermagem 2017; 25:e2954. [PMID: 29211196 PMCID: PMC5738874 DOI: 10.1590/1518-8345.1950.2954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 08/27/2017] [Indexed: 12/05/2022] Open
Abstract
Objective: to analyze the manifestation of the defining characteristics of the nursing
diagnoses of ineffective breathing pattern and impaired spontaneous ventilation,
of the NANDA International and the defining characteristics identified in the
literature for the concept of “ventilation” in adult patients hospitalized in an
intensive care unit with use of oxygen therapy. Method: clinical diagnostic validation study, conducted with 626 patients in intensive
care using oxygen therapy, in three different modalities. Multiple correspondence
analysis was used to verify the discriminative capacity of the defining
characteristics and latent class analysis to determine the diagnostic accuracy of
them, based on the severity level defined by the ventilatory mode used. Results: in the multiple correspondence analysis, it was demonstrated that the majority of
the defining characteristics presented low discriminative capacity and low
percentage of explained variance for the two dimensions (diagnoses). Latent class
models, separately adjusted for the two diagnoses, presented a worse fit, with
sharing of some defining characteristics. Models adjusted by level of severity
(ventilation mode) presented better fit and structure of the component defining
characteristics. Conclusion: clinical evidence obtained in the present study seems to demonstrate that the set
of defining characteristics of the two nursing diagnoses studied fit better in a
single construct.
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Affiliation(s)
| | | | | | | | - Stela Maris de Jezus Castro
- PhD, Adjunct Professor, Departamento de Estatística, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
| | - Miriam de Abreu Almeida
- PhD, Associate Professor, Nursing School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
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Stefani LC, Gutierrez CDS, Castro SMDJ, Zimmer RL, Diehl FP, Meyer LE, Caumo W. Derivation and validation of a preoperative risk model for postoperative mortality (SAMPE model): An approach to care stratification. PLoS One 2017; 12:e0187122. [PMID: 29084236 PMCID: PMC5662221 DOI: 10.1371/journal.pone.0187122] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/13/2017] [Indexed: 12/20/2022] Open
Abstract
Ascertaining which patients are at highest risk of poor postoperative outcomes could improve care and enhance safety. This study aimed to construct and validate a propensity index for 30-day postoperative mortality. A retrospective cohort study was conducted at Hospital de Clínicas de Porto Alegre, Brazil, over a period of 3 years. A dataset of 13524 patients was used to develop the model and another dataset of 7254 was used to validate it. The primary outcome was 30-day in-hospital mortality. Overall mortality in the development dataset was 2.31% [n = 311; 95% confidence interval: 2.06–2.56%]. Four variables were significantly associated with outcome: age, ASA class, nature of surgery (urgent/emergency vs elective), and surgical severity (major/intermediate/minor). The index with this set of variables to predict mortality in the validation sample (n = 7253) gave an AUROC = 0.9137, 85.2% sensitivity, and 81.7% specificity. This sensitivity cut-off yielded four classes of death probability: class I, <2%; class II, 2–5%; class III, 5–10%; class IV, >10%. Model application showed that, amongst patients in risk class IV, the odds of death were approximately fivefold higher (odds ratio 5.43, 95% confidence interval: 2.82–10.46) in those admitted to intensive care after a period on the regular ward than in those sent to the intensive care unit directly after surgery. The SAMPE (Anaesthesia and Perioperative Medicine Service) model accurately predicted 30-day postoperative mortality. This model allows identification of high-risk patients and could be used as a practical tool for care stratification and rational postoperative allocation of critical care resources.
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Affiliation(s)
- Luciana Cadore Stefani
- Department of Surgery, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Anesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Medical Science Postgraduation Program,- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- * E-mail:
| | - Claudia De Souza Gutierrez
- Anesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Medical Science Postgraduation Program,- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | - Rafael Leal Zimmer
- Medical Science Postgraduation Program,- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Felipe Polgati Diehl
- Anesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Leonardo Elman Meyer
- Anesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Wolnei Caumo
- Department of Surgery, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Anesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
- Medical Science Postgraduation Program,- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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da Silva Fink J, de Mello ED, Beghetto MG, Luft VC, de Jezus Castro SM, de Mello PD. Nutritional Assessment Score: A new tool derived from Subjective Global Assessment for hospitalized adults. Clin Nutr 2017; 37:706-711. [PMID: 28330627 DOI: 10.1016/j.clnu.2017.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 02/01/2017] [Accepted: 02/17/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS There is no method to be used as a reference standard for nutritional assessment. This study aims to develop and verify the performance of a new tool, based on the Item Response Theory (IRT), from the Subjective Global Assessment (SGA) questionnaire, in hospitalized adult patients. METHODS Retrospective cohort study, composed by secondary database, formed by patients included from October 2005 to June 2006. The new tool presented was developed through the usage of cumulative models from the IRT. Out of 1503 evaluated patients, 2/3 were randomly selected to the development sample of the new tool and 1/3 to the performance verification sample. RESULTS After item adjustments, the "Nutritional Assessment Score" (NAS) was proposed, with reduced number of questions, and, in comparison to SGA, less polytomic items. NAS demonstrates association to variables that are clinically relevant (hospital mortality, long hospital stay, serum albumin and body mass index) and has shown itself to be more precise to patients with the worst degrees of nutritional status. CONCLUSIONS Results point to the validation of the NAS in detecting, accurately, the nutritional status of hospitalized patients.
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Affiliation(s)
- Jaqueline da Silva Fink
- School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, n° 2400. Santa Cecília District, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Elza Daniel de Mello
- School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, n° 2400. Santa Cecília District, Porto Alegre, Rio Grande do Sul, Brazil
| | - Mariur Gomes Beghetto
- School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, n° 2400. Santa Cecília District, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vivian Cristine Luft
- School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, n° 2400. Santa Cecília District, Porto Alegre, Rio Grande do Sul, Brazil
| | - Stela Maris de Jezus Castro
- School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, n° 2400. Santa Cecília District, Porto Alegre, Rio Grande do Sul, Brazil
| | - Paula Daniel de Mello
- School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, n° 2400. Santa Cecília District, Porto Alegre, Rio Grande do Sul, Brazil
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Coppe BC, Borille BT, Fiorentin TR, Jacques ALB, Fagundes AC, Castro SMDJ, Remy LS, Pechansky F, Limberger RP. Multianalytical Method Validation for Qualitative and Quantitative Analysis of Solvents of Abuse in Oral Fluid by HS-GC/MS. Int J Anal Chem 2016; 2016:1029286. [PMID: 27274728 PMCID: PMC4870359 DOI: 10.1155/2016/1029286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/20/2016] [Accepted: 04/06/2016] [Indexed: 11/25/2022] Open
Abstract
The use of oral fluid as a biological matrix to monitor the use of drugs of abuse is a global trend because it presents several advantages and good correlation to the blood level. Thus, the present work aimed to develop and validate an analytical method for quantification and detection of solvents used as inhalants of abuse in oral fluid (OF), using Quantisal™ as collector device by headspace and gas chromatography coupled with a mass detector (HS-GC/MS). Chromatographic separation was performed with a ZB-BAC1 column and the total time of analysis was 11.8 min. The method showed good linearity (correlation coefficient higher than 0.99 for all solvents). The limits of detection ranged from 0.05 to 5 mg/L, while the lower limits of quantification ranged from 2.5 to 12.5 mg/L. Accuracy, precision, matrix effect, and residual effect presented satisfactory results, meeting the criteria accepted for the validation of bioanalytical methods. The method showed good selectivity considering that, for solvents coeluting at the same retention time, resolution was performed by the mass detector. The method developed proved to be adequate when applied in OF samples from users of drugs and may be used to monitor the abuse of inhalants in routine forensic analyses.
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Affiliation(s)
- Bruna Claudia Coppe
- Postgraduate Program in Pharmaceutical Sciences, School of Pharmacy, Federal University of Rio Grande do Sul, Avenida Ipiranga 2752, Santana, 90610-000 Porto Alegre, RS, Brazil
| | - Bruna Tassi Borille
- Postgraduate Program in Pharmaceutical Sciences, School of Pharmacy, Federal University of Rio Grande do Sul, Avenida Ipiranga 2752, Santana, 90610-000 Porto Alegre, RS, Brazil
| | - Taís Regina Fiorentin
- Postgraduate Program in Pharmaceutical Sciences, School of Pharmacy, Federal University of Rio Grande do Sul, Avenida Ipiranga 2752, Santana, 90610-000 Porto Alegre, RS, Brazil
| | - Ana Laura Bemvenuti Jacques
- Postgraduate Program in Pharmaceutical Sciences, School of Pharmacy, Federal University of Rio Grande do Sul, Avenida Ipiranga 2752, Santana, 90610-000 Porto Alegre, RS, Brazil
| | - Ana Claudia Fagundes
- Postgraduate Program in Pharmaceutical Sciences, School of Pharmacy, Federal University of Rio Grande do Sul, Avenida Ipiranga 2752, Santana, 90610-000 Porto Alegre, RS, Brazil
| | - Stela Maris de Jezus Castro
- Department of Statistics, Federal University of Rio Grande do Sul, Avenida Bento Gonçalves 9500, 91509-200 Porto Alegre, RS, Brazil
| | - Lysa Silveira Remy
- Center for Drug and Alcohol Research, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos 2350, Santana, 90035-903 Porto Alegre, RS, Brazil
| | - Flavio Pechansky
- Center for Drug and Alcohol Research, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos 2350, Santana, 90035-903 Porto Alegre, RS, Brazil
| | - Renata Pereira Limberger
- Postgraduate Program in Pharmaceutical Sciences, School of Pharmacy, Federal University of Rio Grande do Sul, Avenida Ipiranga 2752, Santana, 90610-000 Porto Alegre, RS, Brazil
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Castro SMDJ, Cúri M, Torman VBL, Riboldi J. Funcionamento Diferencial do Item no Inventário de Depressão Beck. Rev bras epidemiol 2015; 18:54-67. [DOI: 10.1590/1980-5497201500010005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 06/05/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Diversos estudos mostram o Funcionamento Diferencial do Item (DIF) em itens do Inventário de Depressão Beck (BDI), ao compararem homens e mulheres. A presença de um grande número de itens com DIF no BDI é uma severa ameaça à validade da medida da intensidade de sintomas depressivos obtida pela Teoria da Resposta ao Item (TRI) e às conclusões baseadas nos escores derivados dos itens com e sem DIF. OBJETIVO: Os objetivos deste estudo foram identificar esses itens do BDI, ajustar o modelo de TRI para itens constrangedores (modelo 2), o qual acomoda itens com a presença de DIF, e comparar esses resultados com os do ajuste do modelo logístico de dois parâmetros tradicional da TRI (modelo 1). MÉTODOS: Os resultados obtidos com ambos os modelos foram comparados. RESULTADOS: Os itens que apresentaram DIF foram: tristeza, sentimento de fracasso, insatisfações, culpa, punição, choro, fatigabilidade e perda da libido. Os resultados do ajuste dos dois modelos são similares quanto à discriminação, gravidade (à exceção dos itens com DIF) e no cálculo de escores para os indivíduos. Apesar disso, o modelo 2 é vantajoso, pois mostra as diferenças em gravidade do sintoma depressivo para os grupos avaliados, trazendo, dessa forma, mais informação ao pesquisador sobre a população estudada. CONCLUSÃO: Esse modelo, que tem um alcance mais amplo em termos de população-alvo, pode ser uma ótima alternativa na identificação e acompanhamento de indivíduos com potencial depressivo.
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Affiliation(s)
| | | | | | - João Riboldi
- Universidade Federal do Rio Grande do Sul, Brasil
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Castro SMDJ, Trentini C, Riboldi J. Item response theory applied to the Beck Depression Inventory. Rev Bras Epidemiol 2011; 13:487-501. [PMID: 20857035 DOI: 10.1590/s1415-790x2010000300012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 07/12/2010] [Indexed: 11/22/2022] Open
Abstract
The Beck Depression Inventory (BDI), a scale that measures the latent trait intensity of depression symptoms, can be assessed by the Item Response Theory (IRT). This study used the Graded-Response model (GRM) to assess the intensity of depressive symptoms in 4,025 individuals who responded to the BDI, in order to efficiently use the information available on different aspects enabled by the use of this methodology. The fit of this model was done in PARSCALE software. We identified 13 items of the BDI in which at least one response category was not more likely than others to be chosen, so that these items had to be categorized again. The items with greater power of discrimination were sadness, pessimism, feeling of failure, dissatisfaction, self-hatred, indecision, and difficulty of work. The most serious items were weight loss, suicidal ideas, and social withdrawal. The group of 202 individuals with the highest levels of depressive symptoms was comprised by 74% of women and almost 84% had a diagnosis of a psychiatric disorder. The results show gains resulting from use of IRT in the analysis of latent traits.
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