Depression, quality of life, and body composition in patients with end-stage renal disease: a cohort study

Objective: To prospectively evaluate depressive symptoms, nutritional status, and quality of life (QoL) and search for possible associations in patients with end-stage renal disease undergoing hemodialysis. Methods: A cohort study of 104 adult patients with end-stage renal disease undergoing hemodialysis was conducted. Anthropometric, clinical, and biochemical variables were evaluated after a midweek hemodialysis session. The participants’ body composition was assessed by direct segmental multi-frequency bioimpedance analysis. The WHOQOL-Bref questionnaire was used to evaluate QoL. Participants were separated into two groups - depressive symptoms and no depressive symptoms - at inclusion and evaluated annually for 2 years thereafter using the Beck Depression Inventory. Survival analysis used the Kaplan-Meier method and Cox regression analysis for the goodness of fit of associated factors. All-cause mortality was the outcome of interest. Results: Participants’ mean age was 55.3±15.6 years, 60% were male, and the median time on hemodialysis was 17.5 (8.0-36.8) months. Thirty-two patients had depressive symptoms and a significantly lower QoL compared with the 72 patients in the no depressive symptoms group. The fitted outcome model showed that lean body mass had a protective effect against all-cause mortality (hazard ratio [HR] = 0.89; 95%CI 0.80-0.99; p = 0.038). Conclusion: Depressive symptoms were highly prevalent in the cohort, and correlated with the physical and psychological components of the QoL life questionnaire, as well as with C-reactive protein and phosphorus levels. Lean body mass was protective for the assessed outcome.

Pacientes em hemodiálise: estado inflamatório emassa magra corporal / Hemodialysis patients: inflammatory status and lean body mass

Objetivos: Investigar a relação do estado inflamatório com a massa magra corporal de pacientes em hemodiálise.Métodos: Um estudo transversal observacional incluiu pacientes em hemodiálise há pelo menos três meses. A análise da composição corporal foi realizada por bioimpedância segmentar multi-frequência (InBody 520®). O estado nutricional associado à inflamação foi avaliado usando o instrumento que computa o Escore Desnutrição-Inflamação.Resultados: A amostra incluiu 59 indivíduos, sendo 30 mulheres. A idade média foi de 58,7±14,4 anos, a mediana do tempo em hemodiálise foi de 24 (9-49) meses, a média do peso seco estimado foi 67,0±14,7 kg e a média de massa magra foi 29,7±5,5 kg. A mediana do nível sérico de proteína C-reativa ultrassensível foi 8,6 (3,9-18,0) mg/L e acima do limite normal (≤ 5,0 mg/L), sugerindo a presença de inflamação.O escore desnutrição-inflamação teve mediana de 4 (2-6). Houve correlação significativa entre o escore desnutrição-inflamação e a idade(rs=0,350, p menor do que 0,01) e com o tempo em diálise: (rs=0,320, p menor do que 0,05). Inflamação avaliada pelo nível de proteína C-reativa ultrassensível foi significativamente associada à massa magra (rs=-0,283, p menor do que 0,05).Conclusões: O aumento do tempo em hemodiálise e a idade aumentada estiveram associados com pior estado nutricional. Nesta população, aparentemente quanto menor a massa magra corporal maior o nível de proteína C-reativa ultrassensível, sugerindo uma possível associação entre a inflamação e a massa magra corporal nestes pacientes...

AIMS: To investigate the relationship of the inflammatory status with the lean body mass in hemodialysis patients.METHODS: A cross-sectional observational study included patients on hemodialysis for at least three months. The body composition analysis was performed by segmental multi-frequency bioimpedance (InBody 520�). The nutritional status associated with inflammation was evaluated using the instrument that computes the Malnutrition-Inflammation Score.RESULTS: The sample included 59 subjects, 30 were female. The mean age was 58.7 � 14.4 years, the median time on dialysis was 24 (9-49) months, the mean estimated dry weight was 67.0 � 14.7 kg and mean lean body mass was 29.7 � 5.5 kg. The median serum level of ultrasensitive C-reactive protein was 8.6 (3.9 to 18.0) mg / L and above the normal limit (equal or less than 5.0 mg / L), suggesting the presence of inflammation. The malnutrition-inflammation score had a median of 4 (2-6). There was a significant correlation between the score malnutrition-inflammation and age (rs = 0.350, p less than 0.01) and with time on dialysis: (rs = 0.320, p less than 0.05). Inflammation assessed by the level of ultrasensitive C-reactive protein was significantly associated with lean body mass (rs = - 0.283, p less than 0.05).CONCLUSIONS: The increased time on dialysis and increased age were associated with poorer nutritional status. In this population, apparently the lower lean body mass the higher level of ultrasensitive C-reactive protein, suggesting a possible association between inflammation and lean body mass in these patients...

Reflexões sobre a importância do currículo informal doestudante de medicina / Reflections on the importance of the informal curriculum of themedical student

Objetivos: O presente trabalho analisa aspectos das oportunidades de formação pessoal do acadêmico de medicina e sua contribuição para os serviços de saúde.Fonte de dados: Bases de dados Medline, LILACS e SciELO.Síntese dos dados: Trata-se de uma revisão de literatura por assunto. A saúde no Brasil tem sido abordada e analisada em diversas publicações. No entanto, a participação de estudantes da área da saúde, em especial da medicina, não é considerada como um dos elementos que nela possa ter impacto. Diversas atividades acadêmicas podem ter relevância sobre a saúde, e a participação do aluno pode ser assim considerada. No Brasil ocorreu um aumento no número de escolas médicas desde 1832 e, consequentemente, um aumento de alunos. Também se observa uma busca por maior qualidade na formação acadêmica, com diretrizes específicas para modificação nos currículos das escolas, exaradas pelo Conselho Nacional de Educação e Câmara de Educação Superior. As atividades extracurriculares, que constituem o currículo informal, são previstas nessa regulamentação, na qual os cursos devem disponibilizar oportunidades para que ocorra a busca de forma espontânea, visando a complementação da formação acadêmica. Como sugestões dessas atividades citam-se a iniciação científica, formação solidária, mobilidade acadêmica, monitorias, ligas acadêmicas, entre outras, que os alunos constroem espontaneamente.Conclusões: Através do aprimoramento do currículo informal, os alunos do curso de medicina agregam habilidades e práticas que cooperam para a melhoria do cuidado de pacientes, contribuindo para o alcance das metas em saúde no país.

Aims: This paper examines aspects of staff training opportunities for medical students and their contribution for health services. Source of data: Medline, LILACS and SciELO databases. Summary of findings: This is a review of the literature by subject. Health in Brazil has been discussed and analyzed in several publications. However, the participation of students in the health field, especially medicine, is not considered one of the elements that may impact it. Several academic activities may be relevant to health, and student participation can be considered. In Brazil, there was an increase in medical schools since 1832, and consequently an augmented number of students. Also there is a quest for higher quality in academic education, with specific guidelines for changes in the curricula of schools, instituted by National Council of Education and Board of Higher Education. The extracurricular activities that constitute the informal curriculum, are provided in this regulation, in which courses should provide opportunities for the search to occur spontaneously, in order to complement the academic education. Activities such as: undergraduate research, joint training, academic mobility, peer tutoring, academic leagues, among others, are a part of the informal curriculum that students build spontaneously. Conclusions: By improving the informal curriculum, the students of medicine add skills and practices that work together to improve patient care, contributing to the achievement of health targets in the country.