Psychometric Properties of the Brazilian Version of the Quality of Dying and Death for Adult Family Members of ICU Patients

Death is a complex, subjective phenomenon that requires an understanding of experiences to be qualified to provide care during the end-of-life process. This study aimed to analyze the psychometric properties of the Portuguese version (Brazil) of the Quality of Dying and Death (QODD) scale on family members of patients who died in adult intensive care units. A methodological study was conducted with 326 family members of patients that died in three ICUs of public hospitals in the state of São Paulo, Brazil. For this study, the QODD 3.2a (25 items and six domains) was administered during the period from December 2020 to March 2022. The analysis was performed using the classic theory of the tests and the goodness of fit of the model was tested using confirmatory factor analysis. We have used Spearman's correlation coefficients between the scores of the overall scale and domains. Cronbach's alpha coefficient and the intraclass correlation coefficient (ICC) were used for the evaluation of internal consistency and temporal stability, respectively. The Horn's parallel analysis indicated two factors that were not confirmed in the exploratory factor analysis. A single factor retained 18 of the initial 25 items and the analysis of the goodness of fit to the unidimensional model resulted in the following: CFI = 0.7545, TLI = 0.690, chi-squared = 767.33, df = 135, RMSEA = 0.121 with 90%CI, and p = 5.04409. The inter-item correlations indicated a predominance of weak correlations among the items of the instrument. The items with the largest number of moderate correlations were questions 13b, 9b, and 10b and a strong correlation was found between questions 15b and 16b. Cronbach's alpha coefficient was 0.8 and the ICC was 0.9. The Quality of Dying and Death-Version 3.2a (intensive therapy) in Brazilian Portuguese has a unidimensional structure and acceptable reliability. However, it did not obtain a good fit to the proposed factorial model

Subjective social status and mortality: the English Longitudinal Study of Ageing

Self-perceptions of own social position are potentially a key aspect of socioeconomic inequalities in health, but their association with mortality remains poorly understood. We examined whether subjective social status (SSS), a measure of the self-perceived element of social position, was associated with mortality and its role in the associations between objective socioeconomic position (SEP) measures and mortality. We used Cox regression to model the associations between SSS, objective SEP measures and mortality in a sample of 9972 people aged ≥ 50 years from the English Longitudinal Study of Ageing over a 10-year follow-up (2002-2013). Our findings indicate that SSS was associated with all-cause, cardiovascular, cancer and other mortality. A unit decrease in the 10-point continuous SSS measure increased by 24 and 8% the mortality risk of people aged 50-64 and ≥ 65 years, respectively, after adjustment for age, sex and marital status. The respective estimates for cardiovascular mortality were 36 and 11%. Adjustment for all covariates fully explained the association between SSS and cancer mortality, and partially the remaining associations. In people aged 50-64 years, SSS mediated to a varying extent the associations between objective SEP measures and all-cause mortality. In people aged ≥ 65 years, SSS mediated to a lesser extent these associations, and to some extent was associated with mortality independent of objective SEP measures. Nevertheless, in both age groups, wealth partially explained the association between SSS and mortality. In conclusion, SSS is a strong predictor of mortality at older ages, but its role in socioeconomic inequalities in mortality appears to be complex

(IN)DIFFERENCE: A STUDY OF THE POST-STRUCTURALISM REASONING

Structuralism is a theory that needs to be addressed and debated, since its assumptions remain latent even after the rise of Cultural Studies. As a matter of fact, we might even say that the rise of the former was only possible after the rise of the latter. So the primary objective of this study is to survey questions about structuralisms and particularly the post-structuralism, promoting critical discussion, primarily addressing Jacques Derrida's ideas found in Structure, sign and play in the discourse of human sciences and in Plato’s Pharmacy. Thus , this article aims to discuss and reflect on the deconstruction by the political focus. Also aims to observe the extent to which critical to take into account the deconstructionism of Derrida's ideas .DOI: https://doi.org/10.47295/mren.v6i1.119

Whole-body fasciculation detection in amyotrophic lateral sclerosis using motor unit MRI (MUMRI)

\ua9 2024 International Federation of Clinical NeurophysiologyObjective: Compare fasciculation rates between amyotrophic lateral sclerosis (ALS) patients and healthy controls in body regions relevant for diagnosing ALS using motor unit MRI (MUMRI) at baseline and 6 months follow-up, and relate this to single-channel surface EMG (SEMG). Methods: Tongue, biceps brachii, paraspinals and lower legs were assessed with MUMRI and biceps brachii and soleus with SEMG in 10 healthy controls and 10 patients (9 typical ALS, 1 primary lateral sclerosis [PLS]). Results: MUMRI-detected fasciculation rates in typical ALS patients were higher compared to healthy controls for biceps brachii (2.40 \ub1 1.90 cm-3min−1 vs. 0.04 \ub1 0.10 cm-3min−1, p = 0.004), paraspinals (1.14 \ub1 1.61 cm-3min−1 vs. 0.02 \ub1 0.02 cm-3min−1, p = 0.016) and lower legs (1.42 \ub1 1.27 cm-3min−1 vs. 0.13 \ub1 0.10 cm-3min−1, p = 0.004), but not tongue (1.41 \ub1 1.94 cm-3min−1 vs. 0.18 \ub1 0.18 cm-3min−1, p = 0.556). The PLS patient showed no fasciculation. At baseline, 6/9 ALS patients had increased fasciculation rates compared to healthy controls in at least 2 body regions. At follow-up every patient had increased fasciculation rates in at least 2 body regions. The MUMRI-detected fasciculation rate correlated with SEMG-detected fasciculation rates (τ = 0.475, p = 0.006). Conclusion: MUMRI can non-invasively image fasciculation in multiple body regions and appears sensitive to disease progression in individual patients. Significance: MUMRI has potential as diagnostic tool for ALS

GESTAÇÃO DE RISCO: PERCEPÇÃO E SENTIMENTOS DAS GESTANTES COM AMNIORREXE PREMATURA

Premature amniorrhexis, risky pregnancy, became a global concern because of the harm to the mother and fetus. Aim to identify the knowledge of women of premature amniorrhexis and get to know their perceptions and their feelings about this pathology. Descriptive study with a qualitative approach, developed in a public maternity ward. 11 women participated while hospitalized with a diagnosis of premature amniorrhexis, in the months of September and October 2007. The collection of semi-structured data was used, from which emerged the categories: Women's knowledge in relation to premature amniorrhexis, requiring information, and their feelings experienced, and reaction before their water broke. The results showed that women know little of the disease, or fear for the life of their children, and do not know what to do before that. Additionally health care professionals should regard women as human beings that need support and understanding.Amniorrexe prematuro, embarazo de riesgo, se convirtió en preocupación mundial debido a los agravios en la gestante y en el feto. Objetivamos identificar el conocimiento de las gestantes sobre amniorrexe prematura y conocer sus percepciones y sus sentimientos ante esta patología. Estudio descriptivo con un enfoque cualitativo, desarrollado en una maternidad pública. Participaron 11 gestantes hospitalizadas con diagnóstico de amniorrexe prematura, en los meses de septiembre y octubre de 2007. Se utilizó en la recogida de datos entrevista semi-estructurada a partir de la cual surgieron las categorías: conocimiento de las gestantes en relación con amniorrexe prematura, que requieren la información, los sentimientos experimentados, la reacción ante la ruptura de la bolsa de aguas. Los resultados mostraron que las mujeres saben poco de la enfermedad, el temor por la vida de sus hijos y no saben qué hacer ante esta situación. De ahí la necesidad de los profesionales de la salud de mirar a las gestantes como seres que necesitan de apoyo y comprensión.Amniorrexe prematura, gestação de risco, tornou-se preocupação mundial devido os agravos na gestante e no feto. Objetivamos identificar o conhecimento de gestantes sobre amniorrexe prematura e conhecer suas percepções e seus sentimentos diante desta patologia. Estudo descritivo com abordagem qualitativa, desenvolvido em uma maternidade pública. Participaram 11 gestantes internadas com o diagnóstico de amniorrexe prematura, nos meses de setembro e outubro de 2007. Utilizou-se na coleta de dados entrevista semi-estruturada de onde emergiram as categorias: conhecimento das gestantes em relação à amniorrexe prematura, necessitando de informações, sentimentos vivenciados, reação diante do rompimento da bolsa das águas. Os resultados revelaram que as gestantes pouco conhecem da patologia, temem pela vida dos filhos e não sabem o que fazer diante dessa situação. Consideramos então a necessidade dos profissionais de saúde olhar para as gestantes como seres que necessitam de apoio e compreensão

Health-related quality of life in patients with venous leg ulcer treated in primary care in Brazil and Portugal

Background Venous ulcers constitute an important public health problem as they can cause disability with consequences for multiple dimensions of quality of life. Objective To describe the quality of life in patients with venous leg ulcer treated in primary care in two cities from Brazil and Portugal. Methods This was a cross-sectional comparative study with a non-probabilistic sample of 171 patients with venous leg ulcers who were treated in primary care in two cities from Brazil and Portugal, namely, Natal and Évora. A form covering sociodemographic and health data and the Medical Outcomes Study 36-Item Short-Form Health Survey were used, and descriptive and inferential analyses were performed. Results Significant differences in age and income were observed between the two samples. Patients with venous leg ulcer from Brazil had lower income and were younger than those from Portugal. Quality of life scores were significantly higher in Portugal for the physical aspects, pain, and social functioning, among domains, and for the physical health dimension and total score of QOL. Conclusion The quality of life was better in Portugal than in Brazil and the differences between the countries need further investigation

A NEW POSSIBILITY FOR SURVEILLANCE: DO WE IDENTIFY ALL CASES OF LEPTOSPIROSIS?

SUMMARY Leptospirosis is a febrile disease with a typically underestimated global incidence, especially in regions where dengue is endemic. Therefore, it is difficult to accurately determine the number of leptospirosis cases in these areas, which contributes to significant under-reporting this disease. In this study, we estimated the number of possible leptospirosis cases among dengue-like cases that were reported during 2008, 2010, and 2012 in the city of Fortaleza, northeast Brazil. Patients were evaluated for dengue and leptospirosis using immunoenzymatic tests for IgM antibodies that were specific to each pathogen. Among the suspected cases of dengue that resulted as negative in laboratory tests, 10.8% (2008), 19.2% (2010), and 30.8% (2012) were confirmed to be leptospirosis. Considering the cases reported by the surveillance authority as dengue that were subsequently discarded based on the laboratory test results, we estimate that the number of actual leptospirosis cases may be 26 to 49 times higher than those diagnosed and reported by the Health Services. Furthermore, we believe that approximately 20% of dengue-like cases may be leptospirosis cases in areas where the two diseases are endemic