A revelação do diagnóstico de doença de Alzheimer: opiniões de cuidadores em uma amostra brasileira

BACKGROUND: Disclosure of the diagnosis of Alzheimer's disease (AD) remains a contentious issue, and has been little studied in developing countries. OBJECTIVE: To investigate the influence of socio-demographic factors and the experience of being a caregiver on opinion about disclosing AD diagnosis to the patient in a Brazilian sample. METHOD: Caregivers of 50 AD patients together with 50 control participants that did not have the experience of being a caregiver of AD patient were interviewed using a structured questionnaire. RESULTS: Most of the participants (73.0%) endorsed disclosure of the diagnosis, while caregivers were less prone to disclose (58.0%) than controls (88.0%; p=0.0007). Logistic regression confirmed that only the experience of being a caregiver was associated with a lesser tendency for disclosure endorsement. CONCLUSION: The majority of participants was in favor of disclosing the diagnosis, but caregivers were less willing to disclose the diagnosis to the AD patient.FUNDAMENTO: A revelação do diagnóstico de doença de Alzheimer (DA) tem sido tema polêmico e pouco estudado em países em desenvolvimento. OBJETIVO: Investigar a influência de fatores sócio-demográficos e a experiência de ter sido cuidador na opinião sobre a revelação do diagnóstico em uma amostra brasileira. MÉTODO: Cuidadores de 50 pacientes com DA e 50 indívíduos controle que não tinham tido experiência como cuidadores de pacientes com DA foram entrevistados com o uso de um questionário estruturado. RESULTADOS: A maioria dos participantes (73,0%) manifestou-se a favor da revelação diagnóstico aos pacientes, mas cuidadores foram menos favoráveis (58,0%) que controles (88,0%; p=0,0007). Regressão logística demonstrou que apenas a experiência como cuidador foi associada com menor tendência a apoiar a revelação do diagnóstico. CONCLUSÃO: A maioria dos participantes foi a favor da revelação do diagnóstico ao paciente, mas aqueles com experiência como cuidadores de pacientes com DA foram menos favoráveis

Savižudybių mediciniški ir visuomeniški aspektai Lietuvoje XX amžiaus pirmojoje pusėje

Tyrimo tikslas. Nustatyti savižudybinio elgesio paplitimo ir prevencijos ypatumus XX amžiaus pirmoje pusėje. Tyrimo metodai ir objektas. Taikytas analitinis tyrinėjimų metodas remiantis mokslinių darbų paieška, kritine straipsnių analize ir pateiktos interpretacijos. Pagrindinis tyrimo objektas buvo moksliniai straipsniai, paskelbti Lietuvos mokslo leidiniuose XX a. pirmoje pusėje. Tyrimo rezultatai ir išvados. Atlikus temos apie savižudybes paiešką Lietuvos mokslo žurnaluose buvo rastos 9 publikacijos: du straipsniai apie originalius mokslinius savižudybių tyrimus, du straipsniai apie atliktą praktinį darbą, keturi apžvalginiai ir informaciniai straipsniai, viename pateiktas teorinis savižudybių rizikos faktoriaus aptarimas. Straipsnius apie savižudybę skelbė įvairių profesijų mokslininkai: keturi psichiatrai, du patologoanatomai ir teismo medikai, po vieną straipsnį vidaus ligų gydytojas, chirurgas ir teisininkas. Nusižudymų skaičius Lietuvoje XX amžiaus pirmoje pusėje buvo vienas mažiausių Europoje, pvz., 1929 m.: Lietuvoje – 9 /100 000 gyv., Austrijoje – 39,9, Vokietijoje – 33,2, Vengrijoje – 29,0, Šveicarijoje – 26,1, Japonijoje – 24,5, Prancūzijoje – 24,5, Danijoje – 24,5, Didžiojoje Britanijoje – 17,6, Švedija – 15,0, Italijoje – 9,5. Populiariausias savižudybės metodas buvo nusinuodijimas – 41,0% (daugiausia actu), pasikardavo – 19,6%. Taigi mechaniškos savižudybės priemonės buvo mažiau populiarios. Tarp mėginančių nusižudyti tris kartus daugiau buvo moterų. Daugiausia mėgino žudytis 20–29 metų amžiaus – 56%. Vienas iš siūlomų prevencijos būdų buvo toks: actas turi būti pardavinėjamas ūkio reikalams ne koncentruoto pavidalo, bet skiedinys, ne stipresnis kaip 30%; kitas – sustiprinti jaunimo charakterį gyvenimo kovai, t. y. svarbus mokyklos ir bažnyčios vaidmuo; trečias – kiekviename mieste įsteigti savižudybių prevencijos biurus ir kt. Pateikta įvairi informacija apie epidemiologinius, klinikinius, visuomeninius, prevencinius ypatumus, būdingus to meto ne tik Lietuvai, bet ir visai Europai. Galima patikimai teigti, kad Lietuvoje savižudybinis elgesys buvo mažiau paplitęs negu daugelyje pasaulio šalių. Žemas savižudybių rodiklis rodo, kad lietuviai neturėtų būti genetiškai nulemta savižudybiniam elgesiui tauta. Raktažodžiai: savižudybės, paplitimas, klinika, prevencija, Lietuva, XX a. pirmoji pusė.Main Aim: characterize the epidemiology and prevention measures of suicidal behaviour in Lithuania in the first half of the XX century. Methods and Object. Using an analytical method, this investigation focused on the search for scientific publications relating to suicide, the critical analysis of these publications and subsequent interpretation of the main findings. The main objects of interest were research articles published in Lithuanian scientific journals in the first half of the XX century. Results and Conclusions. As a result of extensive search, nine articles related to the suicide theme were located in Lithuanian scientific journals from the first half of the 20th century: two articles on original scientific suicide research, two articles on practical work, four review and informative articles and one providing theoretical discussion of suicide risk factor. The authors of these articles were scientists of various professions: four psychiatrists, two pathologoanatomists and forensic experts, one doctor of internal medicine, a surgeon and a lawyer. The suicide rate in Lithuania in the first half of the XX century was one of the lowest in Europe, e.g., in 1929: Lithuania - 9/100 000 inhabitants, Austria - 39.9, Germany - 33.2, Hungary - 29.0, Switzerland - 26.1, France - 24.5, Denmark - 24.5, Great Britain - 17.6, Sweden - 15.0, Italy - 9.5. The most popular methods of suicide were poisoning, mostly by acetic acid, (41.0%) and hanging (19.6%), i.e. mechanical means of suicide were less popular. In that period, women were 3 times more represented amongst those attempting suicide and most suicide attempts (56%) were made by persons in the age range 20-29. One of methods of prevention was the restriction of sale of industrial use concentrated acetic acid, allowing only the sale of vinegar solution (no more than 30%). Other of methods - strengthening the character of young people and emphasising the role of schools and churches in playing an important role and establishing suicide prevention offices in every city. The paper presents extensive information about the epidemiological, clinical, social and preventive aspects that were typical not only in Lithuania, but also in Europe at that time. This analysis of scientific publications show that Lithuania was less prone to suicidal behaviour than many other European countries almost one hundred years ago and thus Lithuania cannot be considered a country with a genetic predisposition to suicide, furthermore revealing that the current high rates of observed suicidal behaviour are a phenomina that have developed since that time. Key words: suicide, epidemiology, clinical manifestations, prevention, Lithuania, the first half of the XX century