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- ItemSomente MetadadadosAvaliação individualizada dos itens da escala de depressão geriátrica abreviada em um ambulatório geriátrico da Universidade Federal de São Paulo(Universidade Federal de São Paulo (UNIFESP), 2016) Silva, Julliana Lianzza Fernandes [UNIFESP]; Gagliardi, Anna Maria Zaragoza [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: In Brazil, the prevalence of depression in elderly ranges from 4.7 to 36.8%, depending on the instrument used and the cutoff points to detect the symptoms. Because the prevalence of this pathology is high and the consequence of not treating are severe, with negative impact on all aspects of life, its correct identification are highly relevant in public health. Objective: Evaluate the performance of the items of GDS-15 in patients diagnosed with major depression, minor depression and no depression, according DSM IV, to reduce the number of items of original scale and thus propose a simplified tool for clinical practice. Methods: Cross-sectional study in elderly patients with preserved cognition and functionality. Date collected for analysis were age, gender, education, functionality, medications, disease, marital status, diagnosis of major and minor depression by DSM IV, score of geriatric depression scale 15 (GDS-15); answers for each GDS-15 item and for the question ?Feels alone even in the presence of others??. The sensitivity, specificity, predictive positive and negative value and the ROC curve were analyzed. Results and discussion: For 242 evaluated patients, the prevalence of depression was 38.8%, the minor depression, 25.25% and major depression, 12.8%. Regarding GDS-15, the question with the best performance was "Feels that life is empty? (S = 82.6% / E= 71.3% ). However, GDS-15 short versions (10, 5, 4 items) had unsatisfactory performance in the screening. We developed a scale with nine items based on GDS-15 and with additional question "Do you feel lonely in presence of other people??. This instrument showed a satisfactory performance and similar ROC area curve when compared with GDS-15 items (area of 0.86 with p> 0.02). Conclusion: "Do you feel that life is empty?" was as the best GDS-15 question for screening of depression. In our findings, validated scales (GDS 10, 5 and 4 items) did not show satisfactory performance. Our scale with 10 items had appropriated performance, although requires validation for its use in clinical practice.
- ItemAcesso aberto (Open Access)Fertility and fecundity of an outpatient sample with schizophrenia(Associação Brasileira de Psiquiatria - ABP, 2006-12-01) Terzian, Angela Cristina Cesar [UNIFESP]; Andreoli, Sergio Baxter [UNIFESP]; Razzouk, Denise [UNIFESP]; Chaves, Ana Cristina [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; UFMT Department of Clinical Medicine; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To determine reproductive rates among patients with schizophrenia who attended the outpatient clinic at the Universidade Federal de São Paulo (UNIFESP). METHOD: All patients with schizophrenia completed a semi-standardized questionnaire, and data from the Brazilian census was used for comparing population rates. RESULTS: 167 patients completed the questionnaires and of these 33 (19.8%) were or had been married and 32 reported being a parent. The fertility rate (number of individuals who had had at least one child divided by the total number of individuals) was 19.4% (25% for females, 15.8% for males, p = 0.14). Fecundity rate was 1.75 for males and 1.69 for females (p = 0.85). A logistic regression analysis identified an association between the later date of the onset of illness and higher rate of marriage (p = 0.003). Gender and the interaction between gender and marital status were significant predictors for fertility (p < 0.05 and p = 0.024, respectively). CONCLUSIONS: Patients with schizophrenia showed lower rates for marital status, fertility and fecundity when compared to standard population rates. However, many patients will become parents during their life time. Therefore, it is imperative to develop services that fulfill their needs, mainly in Brazil, a middle-income country, where resources are scarce and there is no policy for dealing with this reality.
- ItemAcesso aberto (Open Access)Motivation to change drinking behavior: the differences between alcohol users from an outpatient gastroenterology clinic and a specialist alcohol treatment service(Associação Paulista de Medicina - APM, 2005-11-01) Figlie, Neliana Buzi [UNIFESP]; Dunn, John [UNIFESP]; Gomes, Luis Cláudio Santoro [UNIFESP]; Turisco, Janaina [UNIFESP]; Payá, Roberta [UNIFESP]; Laranjeira, Ronaldo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE: For some patients who have developed significant alcohol-related physical disease, total abstinence from alcohol may offer the best chance of survival. The aim of this study was to investigate motivation for treatment in two groups of alcohol users: outpatients from the gastroenterology clinic and outpatients from the specialist alcohol treatment service. DESIGN AND SETTING: Cross-sectional study, at a federally funded public teaching hospital. METHODS: The sample studied was 151 outpatients from the gastroenterology clinic and 175 from the specialist alcohol treatment service. The interview was conducted in the outpatient clinics at the first appointment, and consisted of demographic questions and scales for measuring quality of life, alcohol dependence, pattern of alcohol, motivation for treatment and consequences of alcohol consumption. RESULTS: The results suggested that outpatients from the gastroenterology clinic were less dependent on alcohol, had suffered fewer consequences from alcohol and had fewer emotional and mental health problems than did the outpatients from the alcohol treatment service. In relation to their stages of change, the gastroenterology outpatients presented high precontemplation scores at the beginning of treatment while outpatients of alcohol treatment service showed higher scores in contemplation, action and maintenance. CONCLUSION: The medical treatment may be a reason for the temporary alcohol abstinence behavior among the gastroenterology outpatients.
- ItemAcesso aberto (Open Access)Prevalence of the HLA-DQB1*0602 allele in narcolepsy and idiopathic hypersomnia patients seen at a sleep disorders outpatient unit in São Paulo(Associação Brasileira de Psiquiatria - ABP, 2009-03-01) Coelho, Fernando Morgadinho Santos [UNIFESP]; Pradella-Hallinan, Márcia Lurdes de Cássia [UNIFESP]; Predazzoli Neto, Mario [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Narcolepsy (with and without cataplexy) and idiopathic hypersomnia, are disorders with common features but with different HLA-DQB1*0602 allele prevalence. The present study describes the prevalence of HLA-DQB1*0602 allele in narcoleptics with and without cataplexy and in patients with idiopathic hypersomnia. METHOD: Subjects comprised 68 patients who were diagnosed for narcolepsy or idiopathic hypersomnia and 23 healthy controls according to the International Classification of Sleep Disorders-2. Subjects comprised 43 patients with narcolepsy and cataplexy, 11 patients with narcolepsy but without cataplexy, 14 patients with idiopathic hypersomnia and 23 healthy controls. Genotyping of HLA-DQB1*0602 allele was performed for all subjects. RESULTS: The prevalence of the HLA-DQB1*0602 allele was increased in idiopathic hypersomnia and in narcoleptic patients with and without cataplexy when compared to healthy subjects (p = 0.04; p = 0.03 and p < 0.0001, respectively). CONCLUSIONS: This finding is in accordance with those of previous studies. The gold standard exam of narcolepsy with cataplexy is Hypocretin-1 dosage, but in patients without cataplexy and idiopathic hypersomnia, there are no specific diagnostic lab findings. The presence of the HLA-DQB1* 0602 allele may be important for the differential diagnosis of situations that resemble those sleep disorders such as secondary changes in sleep structure due to drugs' consumption.
- ItemAcesso aberto (Open Access)Tratamento de tuberculose: integração entre assistência hospitalar e rede básica na cidade de São Paulo(Sociedade Brasileira de Pneumologia e Tisiologia, 2009-11-01) Perrechi, Mirtes Cristina Telles [UNIFESP]; Ribeiro, Sandra Aparecida [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the level of access to health care clinics of a population of patients hospitalized for tuberculosis (TB) at two hospitals in the city of São Paulo, Brazil, comparing them with a population of TB patients under outpatient treatment only. METHODS: We compiled sociodemographic, clinical and epidemiological data related to patients hospitalized for TB at two hospitals in the city of São Paulo, Brazil, between January and December of 2007, using a structured questionnaire. We also identified the outpatient clinics to which the patients were referred at discharge. The same variables were evaluated for TB outpatients during the same period, using a database. RESULTS: The study sample consisted of 474 patients (166 inpatients and 308 outpatients: mean age, 41.0 and 39.1 years, respectively). The univariate analysis showed positive associations between hospitalization due to TB and the following variables: 30-39 year age bracket (OR = 2.17); 50-59 year age bracket (OR = 2.17); combination of pulmonary and extrapulmonary forms of TB (OR = 5.31); TB re-treatment (OR = 2.66); seeking treatment at other health care facilities prior to the diagnosis of TB (OR = 2.05); symptom duration of more than 12 weeks (OR = 2.23); and TB diagnosed at hospitals or in emergency rooms (OR = 4.68). The proportion of inpatients who resided in the same regional health district area as that in which the respective hospital was located was 77.6% and 36.8%. The proportion of discharged patients who were referred to outpatient clinics in the same areas was 67.1% and 39.7%, respectively. CONCLUSIONS: Patients hospitalized for TB should be monitored from discharge until their admission to the outpatient clinic.