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- ItemAcesso aberto (Open Access)Assinatura gênica relacionada ao metabolismo de heme e hemoglobina na sepse secundária à pneumonia(Universidade Federal de São Paulo (UNIFESP), 2019-05-30) Leite, Giuseppe Gianini Figueirêdo [UNIFESP]; Salomão, Reinaldo [UNIFESP]; http://lattes.cnpq.br/8370334857007434; http://lattes.cnpq.br/4816321606501748; Universidade Federal de São Paulo (UNIFESP)Objective: In the present study we investigated the gene expression profiles of sepsis patients caused by community-acquired pneumonia (CAP) or hospital acquired pneumonia (HAP) and their relation with heme and hemoglobin metabolism. Methods: Three microarray datasets were used: GSE48080 (S1), E-MTAB-5273 (S2) and GSE65682 (S3). Samples from each data set were grouped according to patient outcomes and sample collection day. Samples of each dataset were grouped according to patients’ outcome and each sample collection day. The DEGs lists were obtained using the R package LIMMA. DEGs of the S1 dataset were used to construct and analyze four co-expression networks using GeneMANIA interaction database and Cytoscape. The analysis of the molecular signature related to the heme metabolism was performed using "Gene sets hallmark" present in Molecular Signatures Database v 6.2. Common DEGs between the signatures had their expression analyzed using the Immuno-Navigator database. Results: Through the analysis of networks in the data set S1, we found modules directly related to the heme/hemoglobin biosynthesis pathway present only in the networks of the surviving groups. The heme/hemoglobin metabolism pathway was found to be enriched in the three cohorts of patients, with four related genes (ALAS2, AHSP, HBD and CA1) common to the three datasets. The gene expression of these genes is related to the outcome in in S1 and S2 patients, being more prominent in follow-up samples. The results obtained through the Immuno-Navigator showed a direct and statistically relationship between the expression of these four genes in samples of PBMC and neutrophils. Conclusion: We conclude that the heme/hemoglobin metabolism pathway is up-regulated in sepsis and may represent a protective response of white cells to the hostile environment present in septic patients.
- ItemSomente MetadadadosDesfecho clínico de carcinoma de tiroide associado à Doença de Graves: experiência de centro de referência brasileiro(Universidade Federal de São Paulo (UNIFESP), 2019-05-30) Santos, Thayana Linhares [UNIFESP]; Maciel, Rui Monteiro De Barros [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: The incidence of thyroid nodules, as well as differentiated thyroid carcinoma (DTC), is higher in patients with Graves’ disease (GD) than in those with normal thyroid function. Some studies have shown that DTC diagnosed in patients with a history of GD has a more aggressive behavior at diagnosis. However, the studies are old and do not include initial risk stratification and response to treatment. Moreover, there is no data related to GD prevalence in a DTC brazilian population followed in reference center. Purpose: Evaluate the GD prevalence in CDT patients, the risk of recurrence and the outcome of DTC patients with previous or concomitant history of GD. Methods: It is about a retrospective observational study, with collected information from electronic and physical medical records in a lapse from 1982 to 2017, focused on DTC/GD patients who have been assisted at the Thyroid Outpatient Clinic of the Discipline of Endocrinology of the Federal University of São Paulo / Paulista Medicine School, São Paulo, Brazil. The risk of recurrence of CDT and response to treatment was determined according to guidelines established by the American Thyroid Association (ATA). Results: From 601 DTC patients, 24 (3,9%) presented previous history of GD, 23 women and 1 man, with a mean age of 41.8 ± 12 years (range: 22-69). Eight patients had TRAb dosage, with only two of them with positive value. Regarding the clinical situation of the diagnosis of DTC, only one case (4%) was incidental and 23 (96%) were clinically suspect patients. Papillary carcinoma was the histological finding in all patients, with 50% classical variant, 46% follicular variant and 4% diffuse sclerosing variant, and two cases presented concomitant xiv follicular and classic variants. Regarding the risk of recurrence, according to the ATA, 58% (14) were classified as low risk of recurrence, 38% (9) intermediate risk and 4% (1) high risk. All patients were treated with total thyroidectomy and 79% with radioactive iodine (mean activity administered: 170 mCi, range: 30-440 mCi). Regarding the response to treatment, 92% (22) presented excellent response and 8% (2) presented structural disease. Conclusion: The prevalence of GD in patients followed by DTC at a Brazilian reference center was 3.9%. The majority of cases (92%) presented excellent response to treatment. Only 8% of the patients presented structural disease and these patients presented a higher risk of recurrence to the DTC diagnosis.
- ItemAcesso aberto (Open Access)Efficiency markets and results: high performance against the public school and its effort for the inclusion of children with disabilities(Revista Brasileira de Educação, 2018-10-11) Freitas, Marcos Cezar de [UNIFESP]; http://lattes.cnpq.br/6855478178963979The article deals with the appropriation that educational entrepreneurial philanthropy has made of strategic documents of the Brazilian education to propose a market logic to public education. The circulation of the keywords efficiency and result naturalizes the business narrative about the value of high performance and empties the public school of inclusive possibilities, especially with regard to the schooling of children with disabilities.
- ItemAcesso aberto (Open Access)Estado nutricional e prognóstico de crianças gravemente doentes(Universidade Federal de São Paulo (UNIFESP), 2010-02-24) Menezes, Fernanda Souza de [UNIFESP]; Leite, Heitor Pons [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background & aims:the prognostic implications of severe disease-related malnutrition have not been clarifiedThis study aimed to determine the prevalence of malnutrition on admission and whether this nutritional disorder is associated with the prognosis of children admitted to a pediatric intensive care unit (PICU). Methods: In a prospective cohort study, 385 children were assessed regarding nutritional status at admission and clinical outcome. The outcome variables were: 30-day mortality, length of PICU stay and duration of mechanical ventilation. Potential outcome variables were: gender, age, diagnosis (clinical, surgical, cardiac disease), septic shock, malnutrition, scores Pediatric Index of Mortality – PIM2 and Pediatric Logistic Organ Dysfunction - PELOD. Patients with a z score < -2 of expected weight for age, length for age or body mass index were considered malnourished. Results: 45.5% of patients were malnourished on admission. Malnutrition was associated with higher length of mechanical ventilation and length of PICU stay, and not with mortality in the univariate analysis. There was association with length of mechanical ventilation in the logistic regression model (OR 1.76, 95% confidence interval 1.08-2.88; p=0.024). Conclusions: The prevalence of malnutrition at admission was high. Malnutrition was not a predictive factor for mortality but showed independent association with length of mechanical ventilation.
- ItemSomente MetadadadosExpanding Postmortem Donor Pool Using Steatotic Liver Grafts: A New Look(Lippincott Williams & Wilkins, 2009-03-27) Noujaim, Huda M.; Goyet, Jean de Ville de; Montero, Edna F. S. [UNIFESP]; Ribeiro, Cristiane M. F.; Capellozzi, Vera L.; Crescentini, Fabio; Casagrande, Matheo; Santos, Regina G.; Curvello, Lillian; Miranda, Marcelo P. de; Genzini, Tercio; HEPATO Hosp Beneficencia Portuguesa São Paulo; Osped Pediat Bambino Gesu Roma; Universidade Federal de São Paulo (UNIFESP); CIP Hosp Beneficencia Portuguesa São Paulo; Universidade de São Paulo (USP)Background. Clinical demand for liver transplant steadily grows while organs offer has reached a plateau years ago. To expand the donor liver pool, various options have been considered including acceptance of suboptimal donors and steatotic grafts, with a risk of poorer outcomes. the latter risk and its relation to the grade of liver graft steatosis have been studied in this prospective clinical study.Methods. One hundred eighteen consecutive liver transplantation (115 patients) performed between May 2002 and March 2008 were prospectively analyzed. According to the grade of steatosis on a 2 hr postreperfusion biopsy, four groups were considered: absence (<5%) (n=34), mild (<30%) (n=40), moderate (30%-60%) (n=23), or severe steatosis (>= 60%) (n=21). Donors and recipients demographic data, and patients and grafts survival rates were compared among the four groups.Results. Eighty-four (71%) grafts presented some degree of steatosis (macrosteatosis: 19.5%, microsteatosis: 47%, mix type: 33.5%). Patient and graft survival were significant lower in the severe steatosis group, as a whole. Grafts with less than 30% predominant macro-, or microsteatosis also had poorer outcomes with lower patient and graft survival rates.Conclusion. Steatotic liver grafts were used on a large scale (71%) in this clinical series. the analysis confirms that using grafts with moderate (>30%) and severe steatosis (>60%) have a negative impact on outcomes. the authors conclude that using these grafts allow a significant increase in organ offer that counterbalances the negative outcome for patients who are not offered a transplant, and this supports the need for further clinical research.
- ItemSomente MetadadadosFactors associated with health-related quality of life after successful kidney transplantation: a population-based study(Springer, 2009-11-01) Bohlke, Maristela; Marini, Stela S.; Rocha, Marcos; Terhorst, Lisoneide; Gomes, Rafael H.; Barcellos, Franklin C.; Irigoyen, Maria Claudia C. [UNIFESP]; Sesso, Ricardo [UNIFESP]; Univ Catolica Pelotas; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Kidney transplantation improves the quality of life of end-stage renal disease patients. the quality of life benefits, however, pertain to patients on average, not to all transplant recipients. the aim of this study was to identify factors associated with health-related quality of life after kidney transplantation.Population-based study with a cross-sectional design was carried out and quality of life was assessed by SF-36 Health Survey Version 1. A multivariate linear regression model was constructed with sociodemographic, clinical and laboratory data as independent variables.Two hundred and seventy-two kidney recipients with a functioning graft were analyzed. Hypertension, diabetes, higher serum creatinine and lower hematocrit were independently and significantly associated with lower scores for the SF-36 oblique physical component summary (PCSc). the final regression model explained 11% of the PCSc variance. the scores of oblique mental component summary (MCSc) were worse for females, patients with a lower income, unemployed and patients with a higher serum creatinine. the regression model explained 9% of the MCSc variance.Among the studied variables, comorbidity and graft function were the main factors associated with the PCSc, and sociodemographic variables and graft function were the main determinants of MCSc. Despite comprehensive, the final regression models explained only a little part of the heath-related quality of life variance. Additional factors, such as personal, environmental and clinical ones might influence quality of life perceived by the patients after kidney transplantation.
- ItemAcesso aberto (Open Access)Hemispheric surgery for refractory epilepsy in children and adolescents: Outcome regarding seizures, motor skills and adaptive function(W B Saunders Co Ltd, 2013-11-01) Hamad, Ana Paula Andrade [UNIFESP]; Caboclo, Luís Otávio Sales Ferreira [UNIFESP]; Centeno, Ricardo Silva [UNIFESP]; Costa, Livia Vianez [UNIFESP]; Ladeia-Frota, Carol [UNIFESP]; Carrete Junior, Henrique [UNIFESP]; Gomez, Nicolas Garofalo; Marinho, Murilo Martinez [UNIFESP]; Yacubian, Elza Márcia Targas [UNIFESP]; Sakamoto, Américo Ceiki [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Inst Neurol & Neurocirugia Cuba; Universidade de São Paulo (USP)Purpose: the aim of the study was to report the seizure outcome, motor skills and adaptive motor functions in a series of children and adolescents who underwent hemispheric surgery, analysing the risk-benefits of surgery.Methods: the clinical course, seizure and motor function outcomes of 15 patients who underwent hemispheric surgery were reviewed.Results: the mean age at surgery was 9.5, with 1-9 years follow-up. the underlying pathologies were Rasmussen encephalitis, vascular disorders, and hemimegalencephaly. All the patients presented with severe epilepsy and different degrees of hemiparesis, although motor functionality was preserved in 80% of the patients. At last follow-up, 67% were seizure free, and 20% rarely experienced seizures. Antiepileptic drugs were reduced in 60%, and complete withdrawal from such drugs was successful in 20% of the patients. the motor outcome following the surgery varied between the patients.Despite the motor deficit after surgery, the post-operative motor function showed unchanged for gross motor function in most (60%), while 27% improved. Similar results were obtained for the ability to handle objects in daily life activities. Sixty percent of the children were capable of handling objects, with somewhat reduced coordination and/or motor speed.Conclusion: Pre-surgical motor function continues to play a role in the pre-surgical evaluation process in order to provide a baseline for outcome. Hemispheric surgery, once regarded as a radical intervention and last treatment resource, may become routinely indicated for refractory hemispheric epilepsy in children and adolescents, with oftentime favourable motor outcomes. (C) 2013 British Epilepsy Association. Published by Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosImplantation of a second glaucoma drainage device(Springer, 2017) Francis, Brian A.; Fernandes, Rodrigo A. B. [UNIFESP]; Akil, Handan; Chopra, Vikas; Diniz, Bruno [UNIFESP]; Tan, James; Huang, AlexPurpose To evaluate success rates in controlling intraocular pressure (IOP) after implantation of a second glaucoma drainage device (GDD) with a Baerveldt glaucoma implant in patients with refractory glaucoma, with a secondary aim of reducing the need for postoperative glaucoma medications. Material and methods This retrospective, noncomparative, interventional study included patients undergoing a second GDD for uncontrolled glaucoma from a tertiary care glaucoma service. Data were obtained from the medical records for the preoperative period and after the 1st, 15th, and 30th day, 3, 6, and 12 months, and then yearly until the last postoperative visit. Visual acuity, IOP, and number of glaucoma medications (NGM) from the follow-up visits were compared to baseline. Success and failure criteria were analyzed based on IOP level or need of glaucoma medications. Results Forty-nine patients were studied, with a mean follow-up time of 25 +/- 21 months. The mean preoperative IOP was 23.7 +/- 8.2 mmHg, and decreased to 14.8 +/- 4.0 mmHg after 1 year, 14.4 +/- 3.9 mmHg after 2 years, and 16.6 +/- 8.5 mmHg after 3 years. The mean preoperative NGM was 3.4 +/- 1.3, and decreased to 2.0 +/- 1.8 after 1 year, 2.5 +/- 1.6 after 2 years, and 2.8 +/- 2.0 after 3 years. Absolute success was 9% after 1 year for a postoperative IOP between 5 and 18 mmHg, and 76% for a postoperative IOP between 5 and 21 mmHg. The qualified success was 88% at the first and second years and 83% at the third year. Conclusion With up to 3 years of follow-up, a second glaucoma drainage device was successful in reducing IOP to below 21 mmHg, but not as successful below 18 mmHg. The success rate is improved with the use of glaucoma medications with up to 3 years of follow-up.
- ItemSomente MetadadadosImportance of Adherence in the Outcome of Juvenile Idiopathic Arthritis(Springer, 2014-04-01) Len, Claudio Arnaldo [UNIFESP]; Miotto e Silva, Vanessa B. [UNIFESP]; Terreri, Maria Teresa R. A. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Medical treatment of juvenile idiopathic arthritis (JIA) has advanced in the last decade, and improved prognosis is a reality in daily clinical practice. Despite this improvement in the quality of treatment, the outcome can still be compromised by modifiable factors, including delayed referral to a specialist, delayed drug treatment, poor adherence to treatment, and early interruption of drug treatment. in this review we discuss the most relevant aspects related to adherence to treatment in JIA, with emphasis on: factors that affect adherence to treatment; effect of poor adherence to treatment on JIA prognosis; when to suspect and how to assess poor adherence to treatment; and strategies to promote adherence to treatment, with an emphasis on information-reinforcement education. Besides presenting the findings of other authors, we also try to report our experience of this subject, which is still a challenge for health professionals.
- ItemSomente MetadadadosOutcomes of 847 childhood-onset systemic lupus erythematosus patients in three age groups(Sage Publications Ltd, 2017) Lopes, Sandra Regina Miyoshi; Gormezano, Natali Weniger Spelling; Gomes, Roberta Cunha; Aikawa, Nadia Emi; Pereira, Rosa Maria Rodrigues; Terreri, Maria Teresa Ramos Ascensão [UNIFESP]; Magalhães, Claudia Saad; Ferreira, Juliana Caires; Okuda, Eunice Mitiko; Sakamoto, Ana Paula [UNIFESP]; Sallum, Adriana Maluf Elias; Appenzeller, Simone; Ferriani, Virginia Paes Leme [UNIFESP]; Barbosa, Cassia Maria; Lotufo, Simone; Jesus, Adriana Almeida de; Andrade, Luiz Eduardo Coelho [UNIFESP]; Campos, Lucia Maria Arruda; Bonfa, Eloisa; Silva, Clovis Artur Almeida da; Universidade Federal de São Paulo (UNIFESP)Objective The objective of this study was to assess outcomes of childhood systemic lupus erythematosus (cSLE) in three different age groups evaluated at last visit: group A early-onset disease (<6 years), group B school age (6 and <12 years) and group C adolescent (12 and <18 years). Methods An observational cohort study was performed in ten pediatric rheumatology centers, including 847 cSLE patients. Results Group A had 39 (4%), B 395 (47%) and C 413 (49%). Median disease duration was significantly higher in group A compared to groups B and C (8.3 (0.1-23.4) vs 6.2 (0-17) vs 3.3 (0-14.6) years, p<0.0001). The median Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI) (0 (0-9) vs 0 (0-6) vs 0 (0-7), p=0.065) was comparable in the three groups. Further analysis of organ/system damage revealed that frequencies of neuropsychiatric (21% vs 10% vs 7%, p=0.007), skin (10% vs 1% vs 3%, p=0.002) and peripheral vascular involvements (5% vs 3% vs 0.3%, p=0.008) were more often observed in group A compared to groups B and C. Frequencies of severe cumulative lupus manifestations such as nephritis, thrombocytopenia, and autoimmune hemolytic anemia were similar in all groups (p>0.05). Mortality rate was significantly higher in group A compared to groups B and C (15% vs 10% vs 6%, p=0.028). Out of 69 deaths, 33/69 (48%) occurred within the first two years after diagnosis. Infections accounted for 54/69 (78%) of the deaths and 38/54 (70%) had concomitant disease activity. Conclusions This large multicenter study provided evidence that early-onset cSLE group had distinct outcomes. This group was characterized by higher mortality rate and neuropsychiatric/vascular/skin organ damage in spite of comparable frequencies of severe cumulative lupus manifestations. We also identified that overall death in cSLE patients was an early event mainly attributed to infection associated with disease activity.
- ItemSomente MetadadadosPrenatal diagnosis of gastric and small bowel atresia: a case series and review of the literature(Taylor & francis ltd, 2016) Tonni, Gabriele; Grisolia, Gianpaolo; Granese, Roberta; Giacobbe, Annamaria; Napolitano, Marcello; Passos, Jurandir Piass [UNIFESP]i; Araujo Junior, Edward [UNIFESP]Objective: To describe seven cases of gastrointestinal tract (GIT) obstructions and to report a skewed review of the literature. Methods: We performed a search of our permanent perinatal database about cases with prenatal ultrasound and MRI diagnosis of gastrointestinal tract obstructions between 2006 and 2013. All cases were followed until hospital discharge and pre-natal diagnosis were confirmed by fetal MRI, postnatal imaging and/or intra-operative findings. Maternal age, parity, gestational age at diagnosis, ultrasound findings, gestational age at delivery, Apgar scores at 1 and 5 min and postnatal outcome have been recorded. Results: We identified seven cases of gastric and small bowel atresia. Karyotype was normal in six cases and abnormal in one co-twin [46, XY dup (20) (qq13.1q13.3)dn] of a dichorionic-diamniotic pregnancy. The mean +/- SD for maternal age, gestational age at diagnosis, gestational at delivery, birth weight and Apgar scores at 1 and 5 min were 30.8 +/- 4.8 years, 29.8 +/- 3.7 weeks, 2507.5 +/- 727.5 g and 5.6 +/- 2.1, 7.6 +/- 1.6, respectively. All fetuses' undergone surgical procedures in the postnatal period and all of them were discharged live from the hospital. Conclusion: Prompted antenatal detection of gastrointestinal tract obstruction using ultrasound proved to be diagnostic in all cases. Fetal MRI aid was a useful complementary diagnostic investigation. Correct pre-natal diagnosis allows adequate counseling, delivery planning and management care by a multidisciplinary team.
- ItemAcesso aberto (Open Access)Prevalence and clinical outcomes of episodes of ventilator-associated pneumonia caused by SPM-1-producing and non-producing imipenem-resistant Pseudomonas aeruginosa(Sociedade Brasileira de Medicina Tropical - SBMT, 2011-10-01) Furtado, Guilherme Henrique Campos [UNIFESP]; Gales, Ana Cristina [UNIFESP]; Perdiz, Luciana Baria [UNIFESP]; Santos, Anderson Fernandes [UNIFESP]; Medeiros, Eduardo Alexandrino Servolo de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Pseudomonas aeruginosa is a leading cause of ventilator-associated pneumonia (VAP) and exhibits high rates of resistance to several antimicrobial drugs. The carbapenens are usually the drugs of choice against this microorganism. However, the carbapenem resistance has increased among these strains worldwide. The presence of metallo-β-lactamases (MBL) has been pointed out as a major mechanism of resistance among these strains. No previous study addressed outcomes of respiratory infections caused by these strains. METHODS: Our group sought to analyze the epidemiology and clinical outcomes of patients with VAP caused by imipenem-resistant P. aeruginosa. A total of 29 clinical isolates of carbapenem-resistant Pseudomonas aeruginosa were screened for metallo-β-lactamase (MBL) genes. RESULTS: Demographic and clinical variables were similar between the SPM-1-producing and non-SPM-1-producing group. Five (17.2%) isolates were positive for blaSPM-1. No other MBL gene was found. All patients were treated with polymyxin B. The infection-related mortality was 40% and 54.2% for SPM-1-producing and -non-producing isolates, respectively. CONCLUSIONS: There were no differences in epidemiological and clinical outcomes between the two groups.
- ItemSomente MetadadadosSubjective distress in a representative sample of outpatients with psychotic disorders(Elsevier Science Bv, 2016) Rezende Andrade, Mario Cesar [UNIFESP]; Slade, Mike; Bandeira, Marina; Evans-Lacko, Sara; Komaroff, Janina; Martin, Denise [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Andreoli, Sergio Baxter [UNIFESP]Background: The affective burden of psychotic disorder has been increasingly recognised. However, subjective reports of distress and its covariates, especially those related to service use, remain under-investigated in patients with psychosis. Methods: This study investigated subjective distress and its covariates in a representative sample of 401 outpatients with a confirmed diagnosis of psychotic disorders in Brazil. Distress was assessed using the corresponding domain of a standardised measure of need - the Camberwell Assessment of Need. Results: Distress was reported as a need by 165 (41%) patients, being met in 78 (20%) and unmet in 87 (22%). Hierarchical logistic regression showed that the presence of distress as a need was predicted by attendance at psychotherapy (OR=3.49, CI=1.62-7.53), presence of suicidal ideation (OR=2.89, CI=1.75-4.79), non-attendance at psychosocial rehabilitation (OR=2.84, CI=1.31-6.19), and higher psychopathology (OR= 1.09, CI=1.06-1.12). An unmet need was predicted by family not accompanying patients to treatment (OR=2.60, CI=1.05-6.44) and higher psychopathology (OR=1.05, CI=1.02-1.09). Limitation: The use of a cross-sectional design and a single questionnaire domain to evaluate distress are the main limitations. Conclusions: Subjective distress is a common unmet need in psychosis, and can be treated. The main clinical implication is that subjective distress in psychosis may be impacted on by family engagement and psycho social interventions. (C) 2015 Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosSubjective distress in a representative sample of outpatients with psychotic disorders(Elsevier Science Bv, 2016) Rezende Andrade, Mario Cesar [UNIFESP]; Slade, Mike; Bandeira, Marina; Evans-Lacko, Sara; Komaroff, Janina; Martin, Denise [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Andreoli, Sergio Baxter [UNIFESP]Background: The affective burden of psychotic disorder has been increasingly recognised. However, subjective reports of distress and its covariates, especially those related to service use, remain under-investigated in patients with psychosis. Methods: This study investigated subjective distress and its covariates in a representative sample of 401 outpatients with a confirmed diagnosis of psychotic disorders in Brazil. Distress was assessed using the corresponding domain of a standardised measure of need - the Camberwell Assessment of Need. Results: Distress was reported as a need by 165 (41%) patients, being met in 78 (20%) and unmet in 87 (22%). Hierarchical logistic regression showed that the presence of distress as a need was predicted by attendance at psychotherapy (OR=3.49, CI=1.62-7.53), presence of suicidal ideation (OR=2.89, CI=1.75-4.79), non-attendance at psychosocial rehabilitation (OR=2.84, CI=1.31-6.19), and higher psychopathology (OR= 1.09, CI=1.06-1.12). An unmet need was predicted by family not accompanying patients to treatment (OR=2.60, CI=1.05-6.44) and higher psychopathology (OR=1.05, CI=1.02-1.09). Limitation: The use of a cross-sectional design and a single questionnaire domain to evaluate distress are the main limitations. Conclusions: Subjective distress is a common unmet need in psychosis, and can be treated. The main clinical implication is that subjective distress in psychosis may be impacted on by family engagement and psycho social interventions. (C) 2015 Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosVariations in reporting of outcomes in randomized trials on diet and physical activity in pregnancy: A systematic review(Wiley, 2017) Rogozinska, Ewelina; Marlin, Nadine; Yang, Fen; Dodd, Jodie M.; Guelfi, Kym; Teede, Helena; Surita, Fernanda; Jensen, Dorte M.; Geiker, Nina R. W.; Astrup, Arne; Yeo, SeonAe; Kinnunen, Tarja I.; Stafne, Signe N.; Cecatti, Jose G.; Bogaerts, Annick; Hauner, Hans; Mol, Ben W.; Scudeller, Tânia Terezinha [UNIFESP]; Vinter, Christina A.; Renault, Kristina M.; Devlieger, Roland; Thangaratinam, Shakila; Khan, Khalid S.Aim Trials on diet and physical activity in pregnancy report on various outcomes. We aimed to assess the variations in outcomes reported and their quality in trials on lifestyle interventions in pregnancy. Methods We searched major databases without language restrictions for randomized controlled trials on diet and physical activity-based interventions in pregnancy up to March 2015. Two independent reviewers undertook study selection and data extraction. We estimated the percentage of papers reporting critically important' and important' outcomes. We defined the quality of reporting as a proportion using a six-item questionnaire. Regression analysis was used to identify factors affecting this quality. Results Sixty-six randomized controlled trials were published in 78 papers (66 main, 12 secondary). Gestational diabetes (57.6%, 38/66), preterm birth (48.5%, 32/66) and cesarian section (60.6%, 40/66), were the commonly reported critically important' outcomes. Gestational weight gain (84.5%, 56/66) and birth weight (87.9%, 58/66) were reported in most papers, although not considered critically important. The median quality of reporting was 0.60 (interquartile range 0.25, 0.83) for a maximum score of one. Study and journal characteristics did not affect quality. Conclusion Many studies on lifestyle interventions in pregnancy do not report critically important outcomes, highlighting the need for core outcome set development.