Evaluation of objective and subjective indicators of death in a period of one year in a sample of prevalent patients under regular hemodialysis

<p>Abstract</p> <p>Background</p> <p>To identify objective and subjective indicators of death in prevalent hemodialysis (HD) patients in a follow-up study of 12 months.</p> <p>Methods</p> <p>The study included end-stage renal disease patients undergoing HD and analyzed demographic and laboratory data from the dialysis unit's records. Baseline data concerning socioeconomic status, comorbidity, quality of life level, coping style and depression were also assessed. For variables that differed in the comparison between survivors and non-survivors, Cox proportional hazards for death were calculated.</p> <p>Results</p> <p>The mortality rate was 13.0%. Non-survivors differed in age, comorbidity, inclusion on the transplant waiting list and physical functioning score. The hazard ratios of death were 8.958 (2.843-28.223; <it>p </it>< 0.001) for comorbidity, 3.992 (1.462-10.902; <it>p </it>= 0.007) for not being on the transplant waiting list, 1.038 (1.012-1.066; <it>p </it>= 0.005) for age, and 0.980 (0.964-0.996; <it>p </it>= 0.014) for physical functioning.</p> <p>Conclusions</p> <p>Comorbidity, not being on the transplant waiting list, age and physical functioning, which reflects physical status, must be seen as risk indicators of death among patients undergoing HD.</p

Distance between residence and the dialysis unit does not impact self-perceived outcomes in hemodialysis patients

<p>Abstract</p> <p>Background</p> <p>Patients have to travel long distances to undergo hemodialysis (HD) in some regions. We aimed to search for an association of the distance between patients’ residence and the dialysis unit with quality of life, depression and coping among end-stage renal disease (ESRD) patients undergoing maintenance HD.</p> <p>Methods</p> <p>We studied 161 ESRD patients undergoing HD during April 2009. Quality of life, depression and coping were assessed by the SF-36, the 10-item CES-D and the Jalowiec Coping Scale, respectively. The sample was stratified in three groups: I-patients residing in Sobral (where the dialysis unit is located); II-patients residing in towns up to 100 km from Sobral; and III-patients residing in towns distant greater than 100 km from Sobral. Analysis of variance was used to detect differences in quality of life and coping scores between the groups. Logistic regression was used to test distance as a predictor of depression.</p> <p>Results</p> <p>There were 47 (29.2%) patients residing in Sobral, 46 (28.6%) up to 100 km away and 68 (42.2%) greater than 100 km from Sobral. There were no differences related to quality of life and coping scores between the groups. Distance was not a predictor of depression.</p> <p>Conclusions</p> <p>Social and cultural factors may explain the lack of differences. Studies from other regions are needed to clarify the distance effects on self-perceived outcomes among HD patients.</p

A experiência brasileira com o core set da classificação internacional de funcionalidade, incapacidade e saúde para lombalgia La experiencia brasileña con el core set de la clasificación internacional de funcionalidad, incapacidad y salud para dorsalgia The Brazilian experience with the international classification of functioning, disability and health core set for low back pain

OBJETIVO: Validar empiricamente o core set da CIF para lombalgia e descrever a funcionalidade de uma amostra de pacientes com lombalgia mecânica crônica inespecífica. MÉTODOS: Vinte e nove pacientes de um centro de reabilitação foram avaliados por meio do core set da CIF para lombalgia e pelo questionário de Roland Morris (QRM) e SF-36. RESULTADOS: Todas as categorias de estruturas do corpo do core set se mostraram comprometidas em ao menos 80% dos pacientes, sendo consideradas validadas. Entre as 19 categorias de Funções do corpo, apenas quatro estavam comprometidas em menos que 80% dos pacientes, sendo consideradas não-validadas, o mesmo foi observado para cinco das 29 de Atividades e participações e cinco das 25 categorias de Fatores ambientais. CONCLUSÕES: As categorias selecionadas para o core set da CIF para lombalgia foram consideradas empiricamente validadas e em conjunto permitiram descrever a multiplicidade de repercussões dessa condição de saúde sobre a funcionalidade das pessoas. O core set da CIF serve para guiar a intervenção terapêutica interdisciplinar.<br>OBJETIVO: Validar empíricamente el core set de la CIF para dorsalgia y describir la funcionalidad de una muestra de pacientes con dorsalgia mecánica crónica inespecífica. MÉTODOS: Veintinueve pacientes de un centro de rehabilitación fueron evaluados por medio del core set de la CIF para dorsalgia, y mediante el cuestionario Roland Moris (QRM) y SF-36. RESULTADOS: Todas las categorías de Estructuras del cuerpo del core set se mostraron comprometidas en por lo menos 80% de los pacientes, siendo consideradas validadas. Entre las 19 categorías de Funciones del cuerpo, sólo cuatro estaban comprometidas en menos de 80% de los pacientes, siendo consideradas como no validadas; lo mismo fue observado para 5 de las 29 categorías de Actividades y participaciones, y 5 de las 25 categorías de Factores ambientales. CONCLUSIONES: Las categorías seleccionadas para el core set de la CIF cuanto a dorsalgia fueron consideradas como empíricamente validadas y, en conjunto, permitieron describir la multiplicidad de repercusiones de esa condición de salud sobre la funcionalidad de las personas. Este core set de la CIF sirve para guiar la intervención terapéutica interdisciplinaria.<br>OBJECTIVE: To empirically validate the ICF Core Set for low back pain, describing functioning, in a sample of chronic unspecific mechanical low back pain patients. METHODS: Twenty-nine patients from a rehabilitation center were assessed with the ICF Core Set for low back pain, Roland Morris Questionnaire (RMQ) and SF-36. RESULTS: All Body structures categories of this ICF Core Set were impaired in at least 80% of the patients, thus they were considered validated. Among the 19 Body functions categories, only four were impaired in less than 80%, thus not-validated, the same was observed in five out of the 29 Activities and participation categories and five of the 25 Environmental factors categories. CONCLUSIONS: The selected categories of the ICF Core Set for low back pain were empirically validated, and together, they allowed the description of functioning of those patients. This ICF Core Set can be used to guide interdisciplinary therapeutic interventions

Depression and quality of life of hemodialysis patients living in a poor region of Brazil Depressão e qualidade de vida entre pacientes em hemodiálise de uma região pobre do Brasil

OBJECTIVE: To determine the correlation between depression and quality of life (QOL) of patients in hemodialysis (HD). METHOD: One hundred and sixty six patients over 18 years of age who had been in HD for at least three months and had no history of transplant. QOL was assessed using the SF-36. To categorize depression, a score > 10 was used on the 10-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). Comparisons between depressed and nondepressed patients were performed using the chi-square test, Student's t-test, and Mann-Whitney test. Multiple regression was performed to assess the predictive variables of patients' QOL. RESULTS: Symptoms of depression were found in 13 (7.8%) patients. The only variable that differed among depressed patients was QOL. Depressed patients presented lower scores in vitality (40.7 vs. 57.3; p = 0.010), role-emotional (25.6 vs. 62.5; p = 0.006), and mental health (50.1 vs. 65.4; p = 0.023). Regression analysis demonstrated that depression was a predictor of role-emotional (OR = 0.981, CI = 0.967-0.996; p = 0.010) and mental health (OR = 0.970, CI = 0.946-0.996; p = 0.022). CONCLUSION: Depressed patients experience a poor QOL because, in addition to their chronically affected physical aspects, they also feel limited in the mental dimensions, which usually have the highest score among non-depressed HD patients.<br>OBJETIVO: Determinar a correlação entre depressão e qualidade de vida (QV) de pacientes submetidos à hemodiálise (HD). MÉTODO: Foram estudados 166 pacientes com idade superior a 18 anos, em HD por pelo menos três meses e sem transplante prévio. O nível de QV foi medido pelo questionário SF-36. Para categorizar depressão foi utilizada a versão de 10 itens do Center for Epidemiologic Studies Depression Scale (CES-D; escore > 10). As comparações entre pacientes com e sem depressão foram realizadas pelos testes do qui-quadrado, t de Student e Mann-Whitney. Regressão múltipla foi realizada para testar variáveis preditivas de QV. RESULTADOS: Sintomas depressivos estavam presentes em 13 (7,8%) pacientes. A única variável que diferiu entre os pacientes com depressão foi QV. Pacientes depressivos apresentaram menor pontuação referente a vitalidade (40,7 vs. 57,3; p = 0,010), aspectos emocionais (25,6 vs. 62,5; p = 0,006) e saúde mental (50,1 vs. 65,4; p = 0,023). A análise de regressão demonstrou que depressão foi preditiva de aspectos emocionais (OR = 0,981, IC = 0,967-0,996; p = 0,010) e de saúde mental (OR = 0,970, CI = 0,946-0,996; p = 0,022). CONCLUSÃO: Pacientes com depressão vivenciam um nível baixo de QV porque, além dos aspectos físicos afetados cronicamente, esses pacientes são afetados nas dimensões mentais que costumam ser as dimensões com melhores pontuações entre os pacientes em HD sem depressão