Factors associated with thrombocytopenia in severe leptospirosis (Weil's disease)

OBJECTIVE: This study was conducted to investigate factors associated with thrombocytopenia in a large cohort of patients with leptospirosis in an endemic area. METHODS: This retrospective study included 374 consecutive patients with leptospirosis who were admitted to tertiary hospitals in Fortaleza, Brazil. All patients had a diagnosis of severe leptospirosis (Weil's disease). Acute kidney injury was defined according to the RIFLE criteria. Thrombocytopenia was defined as a platelet coun

Impact on the Quality of Life of an Educational Program for the Prevention of Work-Related Musculoskeletal Disorders: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Work-related musculoskeletal disorders (WMSD) are a major cause for concern in public health and the main causes of sick leave. Treatments for WMSD have given disappointing results; prevention is the best strategy, but results of preventive measures have not been consistent. To the best of our knowledge there are few studies in literature that evaluated the impact of a specific program aimed at preventing WMSD on the quality of life of employed persons.</p> <p>Methods</p> <p>One hundred and one clerical and production workers in a steel trading company were enrolled in an open-label randomized controlled clinical trial (parallel groups) to compare the efficacy of an educational program for primary prevention of WMSD with control intervention. The primary outcome was a change in the physical functioning domain of the quality of life (QL) measured by Medical Outcomes Study Short Form 36 Health Survey (SF-36). The intervention group underwent six consecutive weekly sessions concerning specific orientations for the prevention of WMSD, while the control group received general health education in an identical schedule. The SF-36 and theses Work Limitation Questionnaire (WLQ) were evaluated at weeks zero, five and 26.</p> <p>Results</p> <p>Baseline characteristics of the interventions groups were comparable, and both groups comprised predominantly young healthy individuals. No significant differences in the variation of the SF-36 and WLQ between the groups were observed at weeks five and 26. However, both groups demonstrated improvement in some aspects of SF-36, suggesting that both educational interventions have beneficial impacts on QL.</p> <p>Conclusions</p> <p>A specific educational program aimed at the preventing of WMSD was comparable with general health orientation for the improvement of QL and work capacity in a sample of healthy workers during a six month period.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00981877">NCT00874718</a></p> <p>Trial Registration</p

Translation and cultural adaptation of quality of life questionnaires: evaluation of its methodology

A maioria das tecnicas disponiveis para avaliacao de qualidade de vida sao baseadas em questionarios, os quais frequentemente sao desenvolvidos em paises de lingua inglesa. O processo de traducao e adaptacao cultural desses questionarios consiste na validacao de um questionario pre-existente, para um determinado contexto cultural, seguindo as seguintes fases: 1) traducao; traducao de volta a lingua original (back-translation); 3) avaliacao por um comite de revisao composto por uma equipe multidisciplinar; 4) pre-teste do questionario traduzido para avaliar equivalencia cultural. Esse processo e caro e demorado e, alem disso, nao ha evidencias na literatura que justifiquem o seu emprego. O objetivo desse estudo e avaliar o processo de traducao e adaptacao cultural de questionarios de qualidade de vida internacionalmente aceitos. Cinquenta paciente com artrite reumatoide (AR) foram entrevistados usando duas versoes dos questionarios HAQ, AIMS-2 e SF-36: versao literal, obtida atraves da traducao literal do questionario original e versao adaptada, resultado do processo de traducao e adaptacao cultural seguindo as normas internacionalmente aceitas. Para cada paciente, nos aplicamos dois questionarios antes e depois da consulta medica de rotina. O questionario, sua ordem de aplicacao e versao foi definida de forma randomizada. As entrevistas foram realizadas por um unico observador. Medidas de avaliacao clinica e laboratorial foram avaliadas simultaneamente. Analise estatistico descritiva foi utilizada para a caracterizacao demografica e clinico-laboratorial dos pacientes avaliados nas diferentes etapas do estudo. O coeficiente de correlacao de Pearson foi usado para avaliar confiabilidade e validade de cada versao dos questionarios. A media de idade (DP) e duracao de doenca foi 47 (11) e 11 (8) anos, respectivamente. A diferenca entre as medias nos componentes fisico e afetivo do AIMS-2 entre a versao literal e a adaptada (O,21 e O, l 1; respectivamente) foi semelhante a diferenca observada durante a aplicacao intra-observador da mesma versao culturalmente adaptada dos mesmos componentes do AIMS-2 (O,03 e O,2) ( os escores dos componentes variam de O a 1O). Os mesmos resultados foram observados quando consideramos outros componentes do AIMS-2, HAQ e SF-36. As versoes literal e adaptada apresentam uma correlacao estatisticamente significante com medidas clinicas e laboratoriais usadas no processo de validacao dos questionarios...(au)BV UNIFESP: Teses e dissertaçõe

Cognitive behavioral therapy for the treatment of fibromyalgia: a randomized controlled trial

Objetivos: Avaliar a eficácia de um programa de terapia cognitivo-comportamental (TCC) no tratamento de pacientes fibromiálgicos Métodos: Sessenta pacientes com fibromialgia (de acordo com os critérios classificação do ACR) foram randomizados em dois grupos: um que foi submeti a uma intervenção com TCC (dividido em subgrupos de 5 pacientes) que consistiu de dez sessões, uma vez por semana, com relaxamento muscular monitorado por eletromiografia (EMG) (3 sessões iniciais) e manejo de estresse psicológico comportamental (7 últimas sessões) e outro com visitas médicas de rotina semanais, pelo mesmo período de tempo. Pacientes de ambos os grui receberam amitriptilina na dose de 25mg/dia ou ciclobenzaprina na dose 10mg/dia, além de paracetamol na dose de 750 mg cada 8 horas quando necessário. Avaliação cega foi realizada em todos os pacientes no início tratamento (TO), após o final de dez semanas (T1) e após três meses do seu final (T2) com os seguintes instrumentos: escala visual analógica de dor (VA questionário genérico SF-36, inventário de ansiedade-estado (DATE), inventário beck de depressão (IBD), escala de melhora (likert scale) e FIQ. O número comprimidos de paracetamol também foi usado como parâmetro de avaliação. Resultados: Nove pacientes (5 do grupo de intervenção e 4 do controle) for excluídas. Os grupos foram homogêneos quanto a variáveis demográfica quantitativas. Observamos diferença estatisticamente significante entre os grupos a favor do grupo submetido a TCC para as variáveis IBD (p= 0,01) e componente saúde mental do SF 36 (p= 0,012). Essa diferença foi observada T1 e permaneceu estável em T2. Os valores médios para essas variáveis grupo de intervenção (TCC) e controle no T0, T1 e T2 foram respectivamente 20.60, 7.56 e 10.60 versus 25.76, 13.96 e 15.61 para IBD; 44.00, 71.80 e 69 versus 38.30, 57.07 e 56.15 para saúde mental. O número médio de comprimi( de paracetamol usado no grupo submetido a TCC foi significantemente difere daquele do grupo controle (p= 0,043). Conclusões: A terapia cognitivo-comportamental foi superior a apenas consultas médicas de rotina nas variáveis depressão, saúde mental e número de comprimidos de paracetamol ingeridos pelas pacientes no período do estudo. Não foi demonstrada, no entanto, superioridade nas demais variáveis avaliadas.BV UNIFESP: Teses e dissertaçõe

Efficacy of Hydroxychloroquine in Hand Osteoarthritis: A Randomized, Double-Blind, Placebo-Controlled Trial

Clinical epidemiolog

Quality of Life of Patients With Recurrent Respiratory Papillomatosis

OBJECTIVES/HYPOTHESIS: Recurrent respiratory papillomatosis (RRP) is a disease with a high disease burden. Few studies have assessed quality of life (QoL) of RRP patients. This study compares QoL of these patients with controls. Associations between QoL and sociodemographic and illness-related factors are examined, as is uptake of psychosocial care and speech therapy. STUDY DESIGN: Prospective cross-sectional questionnaire research. METHODS: Ninety-one RRP patients (response = 67%) from two university hospitals in the Netherlands and Finland completed the following patient reported outcome measures: (HADS), 15-dimensional health-related quality-of-life scale (15D), Voice Handicap Index (VHI) and the RAND 36-item health-related quality-of-life survey instrument (RAND-36) assessing health-related QoL and voice handicap, and they provided sociodemographic, illness-related, and allied healthcare use. Descriptive analyses, χ(2) tests, t tests, analysis of variance tests, and Pearson correlations were computed to describe the study population and to examine differences between groups. RESULTS: RRP patients had significantly higher mean scores on depression, health-related QoL (15D) and on voice problems (VHI), and significantly lower mean scores on anxiety than controls. Dutch patients had more pain and a decreased general health perception (RAND-36) than controls. Dutch patients and older patients were more depressed, women were more anxious, older patients had lower health-related QoL, and smoking was significantly associated with voice handicap. Patients who had received psychosocial care had significantly higher HADS-depression mean scores than patients who did not receive psychosocial care. CONCLUSIONS: Having RRP has significant effect on voice-related QoL and depression, but has no negative effect on anxiety and health-related QoL. Risk factors for decreased functioning are different than previously hypothesized by many authors. Prevention should be aimed at these risk factors. LEVEL OF EVIDENCE: 4. Laryngoscope, 2016