An Assessment of Maternal Quality of Life in the Postpartum Period in Southern Brazil: A Comparison of Two Questionnaires

OBJECTIVES: To assess maternal quality of life (QoL) during the postpartum period and to compare the performance of two QoL questionnaires across a sample of 101 women in southern Brazil. To our knowledge, this is the first study that measures maternal quality of life during the postpartum period in Brazil. INTRODUCTION: There is limited information about postpartum maternal quality of life in Brazil. The are no Portuguese versions of instruments specifically designed to measure quality of life during the postpartum period. METHODS: Research participants completed the Portuguese version of the World Health Organization Quality of Life Assessment-Bref (WHOQOL-BREF) and Multicultural Quality of Life Index (MQLI) questionnaires. The correlations between the MQLI and the discrete areas of WHOQOL-BREF were examined using Pearson Product-Moment Correlation Coefficients. RESULTS: We report a significant correlation between the global MQLI and the four domains of the WHOQOL-BREF scores (p < 0.01). An analysis of variance revealed a significant difference in mean scores in the Psychological and Environment domains according to different socio-economic strata: F (3, 97) = 3.81, p = 0.012 and F (3, 97) = 4.03, p = 0.01, respectively. DISCUSSION: The WHOQOL-BREF questionnaire may be more sensitive than the MQLI in detecting the impact of socioeconomic status on the QoL of postpartum women. CONCLUSION: The sample of postpartum women evaluated in this study presented favorable QoL scores according to both the MQLI and WHOQOL-BREF questionnaires. Our results also indicate that the WHOQOL-BREF and the MQLI questionnaires have a significant correlation in terms of their assessments of postpartum mothers

An assessment of maternal quality of life in the postpartum period in southern Brazil: a comparson of two questionnaires

OBJECTIVES: To assess maternal quality of life (QoL) during the postpartum period and to compare the performance of two QoL questionnaires across a sample of 101 women in southern Brazil. To our knowledge, this is the first study that measures maternal quality of life during the postpartum period in Brazil. INTRODUCTION: There is limited information about postpartum maternal quality of life in Brazil. The are no Portuguese versions of instruments specifically designed to measure quality of life during the postpartum period. METHODS: Research participants completed the Portuguese version of the World Health Organization Quality of Life Assessment-Bref (WHOQOL-BREF) and Multicultural Quality of Life Index (MQLI) questionnaires. The correlations between the MQLI and the discrete areas of WHOQOL-BREF were examined using Pearson Product-Moment Correlation Coefficients. RESULTS: We report a significant correlation between the global MQLI and the four domains of the WHOQOL-BREF scores (p < 0.01). An analysis of variance revealed a significant difference in mean scores in the Psychological and Environment domains according to different socio-economic strata: F (3, 97) = 3.81, p = 0.012 and F (3, 97) = 4.03, p = 0.01, respectively. DISCUSSION: The WHOQOL-BREF questionnaire may be more sensitive than the MQLI in detecting the impact of socioeconomic status on the QoL of postpartum women. CONCLUSION: The sample of postpartum women evaluated in this study presented favorable QoL scores according to both the MQLI and WHOQOL-BREF questionnaires. Our results also indicate that the WHOQOL-BREF and the MQLI questionnaires have a significant correlation in terms of their assessments of postpartum mothers

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Anxiety symptoms in crack cocaine and inhalant users admitted to a psychiatric hospital in southern Brazil

OBJECTIVE: The occurrence of psychiatric comorbidity among individuals with crack or inhalant dependence is frequently observed. The objective of this study was to investigate anxiety symptoms among crack cocaine and inhalant users in southern Brazil. METHODS: The study investigated two groups of volunteers of equal size (n = 50): one group consisted of crack cocaine users, and the other group consisted of inhalant users. Research volunteers completed the Portuguese versions of the State-Trait Anxiety Inventory (STAI), Hamilton Anxiety Rating Scale (HAM-A), and Self-Report Questionnaire (SRQ). RESULTS: Both crack and inhalant users experience significant symptoms of anxiety. Inhalant users presented significantly more anxiety symptoms than crack users according to the HAM-A questionnaire only. In contrast to the results of the HAM-A, the STAI failed to demonstrate a significant difference between the two groups of substance users. SRQ scores revealed that crack and inhalants users had significant degrees of morbidity. CONCLUSION: A significant difference regarding anxiety symptomatology, especially state anxiety, was observed among inhalant and crack users. Anxiety and overall mental psychopathology were significantly correlated in this sample. The results indicate that screening initiatives to detect anxiety and additional psychiatric comorbidities among crack and inhalant users are feasible and relevant

Portuguese version of the Quality of Life Enjoyment and Satisfaction Questionnaire: a validation study Estudio de validación de la versión en portugués del cuestionario sobre calidad de vida: satisfacción y placer

OBJECTIVE: The aim of this study was to demonstrate the validity and reliability of the Portuguese version of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) among substance users in southern Brazil. METHODS: The original English version of the Q-LES-Q was translated into Portuguese taking into account semantic and conceptual equivalence. The Portuguese versions of the Q-LES-Q and the World Health Organization Quality of Life Instrument (WHOQOL-BREF) were used to assess quality of life among crack cocaine and inhalant users. Factorial and reliability analyses as well as correlation studies were conducted to establish the psychometric properties of the Portuguese version of the Q-LES-Q. RESULTS: All areas of the Q-LES-Q achieved significant Cronbach's coefficients. Significant Pearson correlation coefficients were obtained between various subscales of the Q-LES-Q and the four dimensions of the WHOQOL-BREF. Correlations were significant when crack and inhalant users were analyzed separately or conjointly. Inhalant users presented significantly higher scores than crack users in the social (p = 0.035) and general (p = 0.005) subscales of the Q-LES-Q. CONCLUSION: The Portuguese version of the Q-LES-Q possesses sound internal validity. The English version of the Q-LES-Q was adequately adapted to Portuguese. Inhalant users may present lower levels of satisfaction with social life and overall quality of life than crack users. The Portuguese version of the Q-LES-Q is a reliable questionnaire for future research and clinical use with substance users in Brazil.<br>OBJETIVO: Demostrar la validez y consistencia de la versión en portugués del cuestionario sobre calidad de vida: satisfacción y placer (Q-LES-Q) en consumidores de drogas del sur de Brasil. MÉTODOS: Se tradujo la versión original en inglés del Q-LES-Q al portugués tomando en cuenta las equivalencias semántica y conceptual. Se utilizaron la versión en portugués del Q-LES-Q y la escala de calidad de vida de la Organización Mundial de la Salud (WHOQOL-BREF) para evaluar la calidad de vida de personas que consumían basuco (crack) e inhalantes. Se realizaron análisis factoriales y de consistencia y estudios de correlación para establecer las propiedades psicométricas de la versión en portugués del Q-LES-Q. RESULTADOS: Todas las áreas del Q-LES-Q alcanzaron valores significativos del coeficiente de Cronbach. Se obtuvieron coeficientes de correlación de Pearson significativos entre varias subescalas del Q-LES-Q y las cuatro dimensiones de la WHOQOL-BREF. La correlación fue significativa para los consumidores de basuco y de inhalantes por separado y en conjunto. Los consumidores de inhalantes presentaron puntuaciones significativamente mayores que los consumidores de basuco en las subescalas social (P = 0,035) y general (P = 0,005) del Q-LES-Q. CONCLUSIONES: La versión en portugués del Q-LES-Q posee una sólida validez interna. La versión en inglés del Q-LES-Q se adaptó adecuadamente al portugués. Los consumidores de inhalantes pueden presentar niveles más bajos de satisfacción con la vida social y la calidad general de vida que los consumidores de basuco. La versión en portugués del Q-LES-Q es un instrumento confiable tanto para investigaciones futuras como para uso clínico en consumidores de drogas en Brasil

Portuguese version of the quality of life enjoyment and satisfaction questionnaire: a validation study

Objective: The aim of this study was to demonstrate the validity and reliability of the Portuguese version of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) among substance users in southern Brazil. Methods: The original English version of the Q-LES-Q was translated into Portuguese taking into account semantic and conceptual equivalence. The Portuguese versions of the QLES-Q and the World Health Organization Quality of Life Instrument (WHOQOL-BREF) were used to assess quality of life among crack cocaine and inhalant users. Factorial and reliability analyses as well as correlation studies were conducted to establish the psychometric properties of the Portuguese version of the Q-LES-Q. Results: All areas of the Q-LES-Q achieved significant Cronbach’s coefficients. Significant Pearson correlation coefficients were obtained between various subscales of the Q-LES-Q and the four dimensions of the WHOQOL-BREF. Correlations were significant when crack and inhalant users were analyzed separately or conjointly. Inhalant users presented significantly higher scores than crack users in the social (p = 0.035) and general (p = 0.005) subscales of the Q-LES-Q. Conclusion: The Portuguese version of the Q-LES-Q possesses sound internal validity. The English version of the Q-LES-Q was adequately adapted to Portuguese. Inhalant users may present lower levels of satisfaction with social life and overall quality of life than crack users. The Portuguese version of the Q-LES-Q is a reliable questionnaire for future research and clinical use with substance users in Brazil

Depressive symptoms in crack and inhalant users in Southern Brazil

In this study the authors investigated depressive symptoms and correlated psychopathology in crack cocaine and inhalant users in Southern Brazil. Participants completed the Beck Depression Inventory, the Montgomery-Asberg Depression Rating Scale, and the Hamilton Depression Rating Scale. General psychopathology, hopelessness and suicidal tendencies were also investigated. Crack and inhalants users presented significant levels of depressive symptoms and psychiatric morbidity. These disorders were significantly associated with hopelessness and suicidal tendencies. These findings underscore the need for more rigorous and extensive screening efforts to detect and treat depressive symptoms in crack and inhalent users