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    Avaliação do estado de humor, da função sexual e da qualidade de vida em pacientes com insuficiência renal crônica submetidos a hemodiálise

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    Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, 2006.Introdução: A prevalência da doença renal crônica tem aumentado nos últimos anos, tornando-se um problema de saúde pública no mundo. O tratamento dialítico, empregado na fase mais avançada da doença, aumenta a sobrevida dos pacientes e é necessário que essa tenha boa qualidade. Alterações no estado de humor parecem ser muito comuns nos pacientes hemodialisados e permanecem sub-diagnosticadas nesse grupo de pacientes. O estado depressivo parece prejudicar a qualidade de vida e a função sexual. Objetivos: O objetivo geral foi de avaliar parâmetros relacionados ao estado emocional, sexualidade e qualidade de vida em doentes portadores de doença renal crônica recebendo tratamento de hemodiálise. Os objetivos específicos foram estabelecer se há alteração do humor; identificar possível disfunção erétil; avaliar qualidade de vida nesses pacientes; correlacionar alteração do humor com a qualidade de vida referida; correlacionar alteração do humor e disfunção erétil. Métodos: Quarenta e sete pacientes adultos, masculinos, submetidos ao procedimento de hemodiálise há mais de seis meses, foram avaliados em relação ao estado de humor, empregando-se a escala de depressão de Hamilton. A qualidade de vida foi avaliada utilizando o questionário Kidney Disease and Quality of Life Short Form (KDQOL-SF™) e a função sexual o Índice Internacional de Função Erétil (IIEF). Dados clínico-laboratoriais como hemoglobina, hematócrito, albumina, ferritina e dose de diálise (Kt/v) foram obtidas nos prontuários dos pacientes. As análises estatísticas foram realizadas pelo teste exato de Fisher para comparação entre freqüências e o teste de correlação de Spearman para analisar as correlações entre as pontuações obtidas na escala de Hamilton, nos domínios do KDQOL-SF™ e do IIEF. O nível de significância de p<0.05 foi adotado. Resultados: Em relação à escala de depressão de Hamilton, 32 (68 %) pacientes tinha alteração no humor (escore ≥ 7) e 15 (32 %) não apresentaram esta alteração. (escore ≤ 6). Encontramos correlação, significativa e negativa, entre o escore de depressão de Hamilton e os seguintes parâmetros da escala KDQOL-SF™: Lista de “sintomas e problemas” (rs=-0.399, p=0.005) “qualidade da interação social” (rs= -0.433, p = 0.002), “sono” ( rs= -0.585,p = 0.000), “saúde geral” (rs= -0.475,p = 0.000), “bem-estar emocional” (rs= -0.582, p = 0.000), “função social” (rs= -0.354,p = 0.015) e “energia/fadiga” (rs= -0.518,p = 0.000). Os valores obtidos na Escala de Hamilton não apresentaram correlações significativas com os domínios do IIEF (p>0.05). Os escores obtidos nos domínios do IIEF mostraram correlações positivas e significativas com os seguintes domínios do KDQOL-SF™: A função erétil correlacionou-se com “efeitos da doença renal” (rs=0.340,p=0.019), com a “qualidade da interação social” (rs= 0.328, p=0.024), com a “função sexual “(rs=0.583,p=0.000), com “sono” (rs=0.343,p=0.018), com o “funcionamento físico” (rs=0.391,p=0.006), com “saúde geral “ (rs=0.362,p=0.012), com a “função emocional” (rs=0.286,p=0.005) e com a “energia/fadiga” (rs=0.365,p=0.011). A função orgástica apresentou correlações com a “sobrecarga da doença renal” (rs=0.321,p=0.028), com “função sexual” XI (rs=0.508,p=0.000), com “funcionamento físico” (rs=0.384,p=0.007) com a “função física” (rs=0.363,p=0.012) com a “saúde geral” (rs=0.349,p=0.016), com o “bem-estar emocional” (rs=0.324,p=0.026), com “função emocional” (rs=0.321,p=0.028) e com “energia/fadiga” (rs= 0.281,p=0.005). O domínio desejo sexual do IIEF apresentou correlação com “ efeitos da doença renal”(rs= 0.312,p=0.033), com “função sexual” (rs= 0.394,p= 0.006), com “sono” (rs= 0.393,p=0.006), com “funcionamento físico” (rs=0.422,p=0.003), com “saúde geral” (rs= 0.302,p=0.038), com “bem-estar emocional” (rs=0.422,p=0.003) e com “energia e fadiga” (rs=0.398,p=0.005). O domínio satisfação na relação sexual do IIEF apresentou correlação significativa e positiva com “lista de sintomas e problemas” (rs=0.326,p=0.025), com “efeitos da doença renal” (rs= 0.369,p=0.010), com “função sexual”(rs= 0.696,p=0.000), com “funcionamento físico”( rs=0.414,p=0.003), com “saúde geral” (rs=0.412,p=0.004), com “ bemestar emocional” (rs=0.334,p=0.022), com “função emocional” (rs= 0.299,p= 0.041) e com “energia/fadiga” (rs=0.370,p=0.010). O domínio satisfação com a vida sexual do IIEF apresentou correlações positivas e significativas com “ lista de sintomas e problemas” (rs= 0.403,p=0.005), com “efeitos da doença renal” (rs=0.345,p=0.017), com “sobrecarga da doença renal” (rs=0.343,p=0.018) , com “qualidade da interação social”(rs=0.302,p=0.039), com “função sexual” (rs=0.695,p=0.000), com o “sono”(rs=0.288,p=0.049), com “funcionamento físico” (rs=0.331,p=0.023), com “saúde geral” (rs=0.444,p=0.001) , com “bemestar emocional” (rs=0.306,p=0.036) , com “energia e fadiga” (rs=0.314,p=0.032). A soma da pontuação de todos os domínios do IIEF refletindo a função sexual como um todo apresentou correlações positivas e significativas com a “lista de sintomas e problemas” (rs=0.329,p=0.024), com “efeitos da doença renal” (rs=0.369,p=0.010), com “qualidade de interação social” (rs=0.288,p=0.049), com a “função sexual” (rs=0.670,p=0.000) , com o “sono”(rs= 0.336,p=0.21), com “funcionamento físico”(rs=0.429,p=0.002), com a “saúde geral” (rs=0.454,p=0.001) , com o “bem-estar emocional” (rs=0.371 , p=0.010), com a”função emocional”(rs=0.302,p= 0.039), e com “energia/fadiga” ( rs= 0.405,p= 0.004) Utilizando o domínio erétil do IIEF observou-se que 38 dos 47 pacientes apresentaram disfunção erétil (80,8%). Apesar do grande número de pacientes que apresentaram disfunção erétil e alteração no estado de humor pela escala de Hamilton, não houve associação entre depressão e disfunção erétil. (p> 0.05, Teste exato de Fisher) Conclusões: Observamos alto índice de alteração do estado de humor e de disfunção sexual nos pacientes em hemodiálise crônica. As pontuações obtidas na escala de Hamilton apresentaram correlações negativas com vários domínios do questionário de qualidade de vida relacionada à saúde (KDQOLSF ™), sugerindo que o estado depressivo está associado com menores escores de qualidade de vida nos pacientes hemodialisados. Por outro lado, a função sexual, avaliada pelos diferentes domínios do questionário internacional de função erétil (IIEF) apresentou correlações positivas com diferentes domínios do KDQOL-SF™, sugerindo que a disfunção sexual está correlacionada com escores mais baixos de qualidade de vida nos pacientes estudados. Os principais domínios do KDQOL-SF™ que apresentaram relações mais fortes e significativas com a função sexual avaliada pelo IIEF XIII foram: função sexual, sono, funcionamento físico, saúde geral, bem estar - emocional e energia/fadiga. Podemos concluir que os pacientes com insuficiência renal crônica, em hemodiálise, apresentam: alto índice de alteração do humor, a maioria na faixa de depressão leve e distimia; alto índice de disfunção erétil e deterioração da qualidade de vida. Devemos encorajar novos estudos que busquem quantificar a presença de alterações do estado de humor e da disfunção sexual nos pacientes com insuficiência renal crônica, buscando realizar intervenções que visem atenuar esses fatores, tendo em vista as possíveis influências que estas alterações provocam na qualidade de vida dos indivíduos, contribuindo para maior morbidade e mortalidade. ____________________________________________________________________________________ ABSTRACTIntroduction: The prevalence of chronic renal disease has increased in recent years,and disease has become a public health issue worldwide. The dialysis treatment, used in the most advanced stage of the disease, increases the patients’ life expectancy and improves their quality of life. Patients under hemodialysis treatment commonly have mood swings, but these changes are not properly diagnosed. Depressive appears to affect their quality of life and sexual function. Objectives: The general objective was to evaluate parameters related to emotional state, sexuality and quality of life in chronic renal disease patients receiving hemodialysis treatment. The specific objectives were: to determine if there were mood swing; to identify possible erectile dysfunction; to evaluate quality of life in these patients; to correlate mood shift with quality of life; and to correlate mood swings with erectile dysfunction. Methods: Forty seven adult male patients who underwent hemodialysis procedure for over six months were evaluated in relation to mood state, using the Hamilton depression scale. The life quality was evaluated using the questionnaire “Kidney Disease and Quality of Life Short Form” (KDQOL-SF™) questionnaire, and the sexual function was assessed using the “International Index of Erectile Function” (IIEF). Laboratorial data, such as hemoglobin, hematocrit, albumin, ferritin and dialysis dose of (Kt/v), were obtained from the patients files. Statistical analyses were conducted using Fisher’s test for XV comparison frequencies, and the Spearman’s correlation test was used to evaluate the correlation among the results obtained from Hamilton scale over the KDQOL-SF™ and the IIEF domains. The significance level p<0.05 was adopted Results: Based on the Hamilton Depression Scale, 32 (68%) patients had mood shifts and swings (score ≥ 7) and 15 (32%), didn’t (score ≤ 6). We found significant negative correlations among the scores obtained from theHamilton Depression Scale and the following parameters of KDQOL-SF™ scale: “list of symptoms and problems” (rs=-0.399 , p=0.005) “quality of social interaction” (rs= -0.433, p = 0.002), “sleep” (rs= -0.585, p = 0.000), “general health” (rs= - 0.475, p = 0.000), “emotional well-being” (rs= -0.582, p = 0.000), “social function” (rs= -0.354, p = 0.015 ) and “energy/fatigue” (rs= -0.518, p = 0.000). We did not find a significant correlation between the score obtained from the Hamilton Depression Scale and the IIEF domains (p>0.05). However, we found a significant positive among IIEF domains and the following KDQOL-SF™ domains: erectile function was correlated with "effects of renal disease" (rs= 0.340, p=0.019), with "quality of social interaction" (rs= 0.328, p=0.024), with "sexual function" (rs=0.583, p=0.000), with "sleep" (rs=0.343, p=0.018), with "physical functioning" (rs=0.391, p=0.006), with "general health "(rs=0.,362, p= 0.012), with "emotional function" (rs=0.286, p=0.005) and with "energy/fatigue" (rs=0.365, p=0.011). The orgasmic function showed correlations with "overload of renal disease" (rs=0.321, p=0.028), with "sexual function" (rs= 0.508, p=0.000), with "physical functioning" (rs=0.384, p=0.007) with "physical function" (rs=0.363, p=0.012) with "general health" (rs=0.349, p=0.016), with XVI "emotional well-being” (rs=0.324, p=0.026), with "emotional function" (rs= 0.321, p=0.028) and with "energy/fatigue" (rs= 0.281, p=0.005). The sexual domain desire of the IIEF was correlated with "effect of renal disease" (rs= 0.312, p=0.033), with "sexual function" (rs= 0.394 , p= 0,006), with "sleep" (rs= 0.393, p=0.006), with "physical functioning" (rs= 0.422, p=0.003), with "general health" (rs= 0.302, p=0.038), with "emotional well-being" (rs= 0.422, p=0.003), and with "energy/fatigue" (rs= 0.398, p=0.005). The satisfaction in the sexual intercourse domain of the IIEF showed a significant positive correlation with "list of symptoms and problems" (rs= 0.326, p=0.025), with "effect of renal disease" (rs= 0.369 , p=0.010), "sexual function" (rs= 0.696, p=0.000), "physical functioning" (rs=0.414, p=0.003),"general health" (rs=0.412, p=0.004), "emotional well-being" (rs=0.334, p=0.022), "emotional function" (rs= 0.299, p= 0.041) and with "energy /fatigue" (rs=0.370, p=0.010). The satisfaction with sexual life domain of the IIEF had significant positive correlations with "list of symptoms and problems" (rs= 0.403, p=0.005 ), "effect of renal disease" (rs=0.345, p=0.017), “overload of the renal disease" (rs=0.343, p=0.018), "quality of the social interaction" (rs=0.302, p=0.039), "sexual function" (rs=0.695, p=0.000), "sleep" (rs= 0.288, p=0.049), "physical functioning" (rs=0.331, p=0.023), "general health" (rs=0.444, p=0.001), "emotional wellbeing" (rs=0.306, p=0.036), and with "energy/fatigue" (rs=0.314, p=0.032). The IIEF total score reflecting the sexual function as a whole had significant positive and correlations with the "list of symptoms and problems" (rs=0.329, p=0.024), "effect of renal disease" (rs= 0.369, p=0.010), "quality of social interaction" (rs=0.288, p=0.049), "sexual function" (rs=0.670, p=0.000), "sleep" (rs= 0.336, p=0.21), "physical functioning" (rs=0.,429, p=0.002), "general health" (rs= XVII 0.454, p=0.001), "emotional well-being" (rs=0.371, p=0.010), " emotional function" (rs=0.302, p= 0.039), and with "energy/fatigue" (rs= 0.405, p= 0.004). The erectile domain of the IIEF showed that 38 of the 47 patients (80.8%) had erectile dysfunction. Although most patients presented erectile dysfunction and mood shift and swings according to the Hamilton Scale, no correlation between depression and erectile dysfunction was found. (p> 0.05, accurate Fisher ‘s test). Conclusions: We found a high index of mood shift and sexual dysfunction in patients with chronic renal disease under hemodialysis treatment. The scores obtained in the Hamilton Scale showed a negative correlations with some domains of the questionnaire of quality of life related to health (KDQOL-SF™). This suggests that the depressive is associated with a lower score in quality of life for patients under hemodialysis treatment. In contrast sexual function, evaluated by different domains of the international questionnaire of erectile function (IIEF), showed positive correlations with different domains of the KDQOL-SF™, suggests that the sexual dysfunction is correlated with lower scores in quality of life of the patients studied. The main domains of the KDQOL-SF™ that showed stronger correlations with the mood state were: sleep, general health, emotional well-being and energy /fatigue. The main domains of the KDQOL-SF™ that had stronger and more significant correlations with the sexual function evaluated by the IIEF were: sexual function, sleep, physical functioning, general health, emotional well-being and energy/fatigue We can conclude that the patients with chronic renal XVIII insufficiency, under hemodialysis treatment, present: high index of mood shifts, and swings, most having mild depression and dysthymia; high index of erectile dysfunction and poor life quality. These data suggest that these patients life quality is negatively affected by depression. Further studies should be encouraged to measure the degree of conditions such as mood shifts and swings and sexual dysfunction in the patients with chronic renal insufficiency. Well-thought-of interventions seeking to minimize patients’ morbidity and-mortality, may be to minimize the harmful effects of those conditions and consequently improve the patients’ quality of life

    Comportamento depressivo e má qualidade de vida em homens com insuficiência renal crônica submetidos à hemodiálise

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    OBJECTIVE: To assess mood and quality of life in male hemodialysis patients, and to correlate mood swings with the different domains of the quality of life questionnaire. METHOD: Forty-seven male patients undergoing regular hemodialysis for more than six months were included in the study. The Hamilton Rating Scale for Depression and the Kidney Disease Quality of Life Questionnaire, in a version translated into and adapted to Portuguese, were used. RESULTS: The patients' age was 39.4 ± 8.9 years (median ± SD). Depression was observed in 32 (68.1%) patients according to the Hamilton Rating Scale for Depression. A significant negative correlation was found between the results from the Hamilton Rating Scale for Depression and the following parameters of the specific dimensions of the Kidney Disease Quality of Life Questionnaire: list of symptoms and problems (rs = -0.399; p = 0.005), quality of social interaction (rs = -0.433; p = 0.002), and quality of sleep (rs = -0.585; p < 0.001). Among the generic domains, mood showed a significant negative correlation with general health (rs = -0.475; p < 0.001), emotional well-being (rs = -0.354; p = 0.015), social functioning and energy/fatigue (rs = -0.518; p < 0.001). The other parameters of the Kidney Disease Quality of Life Questionnaire did not show significant correlations with the Hamilton Rating Scale for Depression. CONCLUSION: Mood showed a negative correlation with the various scores of quality of life assessed by the Kidney Disease Quality of Life Questionnaire, suggesting a possible influence of mood on the quality of life of chronic renal patients undergoing hemodialysis.OBJETIVO: Avaliar o estado de humor e a qualidade de vida de homens em tratamento hemodialítico, correlacionar as alterações observadas no humor com os diferentes domínios do questionário de qualidade de vida. MÉTODO: Foram incluídos 47 homens em tratamento hemodialítico estável há mais de seis meses. Foram aplicadas a Escala de Hamilton de depressão e o Kidney Disease Quality of Life Questionnaire, questionário de qualidade de vida relacionado à saúde, em sua forma traduzida e adaptada para a língua portuguesa. RESULTADOS: A média da idade dos pacientes era 39,4 ± 8,9 anos. Na avaliação pela Escala de Hamilton, observou-se em 32 (68,1%) pacientes a presença de depressão. Encontramos correlação negativa significativa entre os resultados obtidos na escala de Hamilton e os seguintes parâmetros das dimensões específicas do Kidney Disease Quality of Life Questionnaire: lista de sintomas e problemas (rs = -0,399; p = 0,005), qualidade da interação social (rs = -0,433; p = 0,002) e sono (rs = -0,585; p < 0,001). Entre os domínios genéricos, o estado de humor apresenta correlação negativa significativa com a saúde geral (rs = -0,475; p < 0,001), o bem-estar emocional (rs = -0,354; p = 0,015), a função social e a energia/fadiga (rs = -0,518; p < 0,001). Para os demais parâmetros do Kidney Disease Quality of Life Questionnaire não foram observadas relações significativas com a escala de Hamilton. CONCLUSÃO: O estado de humor apresentou correlação negativa com diversos escores de qualidade de vida avaliados pelo Kidney Disease Quality of Life Questionnaire, sugerindo possível influência do estado de humor na qualidade de vida dos pacientes renais em hemodiálise

    Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

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    International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora
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