Condições de trabalho e saúde de profissionais da linha de frente na pandemia de covid-19 / Working conditions and health of frontline professionals in the COVID-19 pandemic

RESUMO Objetivou-se investigar as condições de trabalho e a saúde física e mental de profissionais de saúde atuantes na linha de frente da covid-19 em serviços de urgência, emergência e terapia intensiva no Brasil, no segundo ano da pandemia. Estudo transversal, com uso de questionário eletrônico, por meio do qual coletaram-se dados sobre condições de trabalho, saúde física e mental, além do instrumento Depression, Anxiety and Stress Scale (DASS-21). A amostra (n=209) incluiu enfermeiros (28,7%), técnicos de enfermagem (30,1%), fisioterapeutas (33%) e médicos (8,2%). Os profissionais possuíam idade média de 34,6 anos e relataram uma carga horária média de 53,5 horas/semana. Verificou-se aumento das horas trabalhadas (62%) e da quantidade de pacientes (84%). A maioria relatou bom relacionamento com o chefe (89%) e satisfação com o trabalho (87%). A prevalência de sintomas de estresse, ansiedade e depressão foi superior a 45%, com predomínio de sintomas graves ou extremamente graves. A prevalência de dor musculoesquelética e fadiga foi de 84,7% e 83,3%, respectivamente. Os profissionais de saúde apresentaram aumento de volume de trabalho e de exigência durante a pandemia de covid-19. Observou-se, ainda, intenso prejuízo à saúde física e mental desses trabalhadores.

ABSTRACT The objective was to investigate the working conditions and physical and mental health of health professionals working on the front lines of COVID-19 in urgent, emergency, and intensive care services in Brazil, in the second year of the pandemic. Cross-sectional study, using an electronic questionnaire, through which data on working conditions, and physical and mental health were collected, in addition to the Depression, Anxiety and Stress Scale (DASS-21) instrument. The sample (n=209) included nurses (28.7%), nursing technicians (30.1%), physiotherapists (33%), and physicians (8.2%). The professionals had an average age of 34.6 years and reported an average workload of 53.5 hours/week. There was an increase in hours worked (62%) and in the number of patients (84%). Most reported a good relationship with their boss (89%) and job satisfaction (87%). The prevalence of symptoms of stress, anxiety, and depression was greater than 45%, with a predominance of severe or extremely severe symptoms. The prevalence of musculoskeletal pain and fatigue was 84.7% and 83.3%, respectively. Health professionals showed an increase in workload and demand during the COVID-19 pandemic. There was also intense damage to the physical and mental health of these workers.

Enhanced Proliferative and Osteogenic Potential of Periodontal Ligament Stromal Cells.

Cell-based therapies using periodontal ligament stromal cells (PDLSC) for periodontal regeneration may represent an alternative source for mesenchymal stromal cells (MSC) to MSC derived from bone marrow (MSC(M)) and adipose tissue (MSC(AT)). We aimed to characterize the osteogenic/periodontal potential of PDLSC in comparison to MSC(M) and MSC(AT). PDLSC were obtained from surgically extracted healthy human third molars, while MSC(M) and MSC(AT) were obtained from a previously established cell bank. Flow cytometry, immunocytochemistry, and cell proliferation analyses provided cellular characteristics from each group. Cells from the three groups presented MSC-like morphology, MSC-related marker expression, and multilineage differentiation capacity (adipogenic, chondrogenic, and osteogenic). In this study, PDLSC expressed osteopontin, osteocalcin, and asporin, while MSC(M) and MSC(AT) did not. Of note, only PDLSC expressed CD146, a marker previously applied to identify PDLSC, and presented higher proliferative potential compared to MSC(M) and MSC(AT). Upon osteogenic induction, PDLSC exhibited higher calcium content and enhanced upregulation of osteogenic/periodontal genes compared to MSC(M) and MSC(AT), such as Runx2, Col1A1 and CEMP-1. However, the alkaline phosphatase activity of PDLSC did not increase. Our findings suggest that PDLSC might be a promising cell source for periodontal regeneration, presenting enhanced proliferative and osteogenic potential compared to MSC(M) and MSC(AT).

Home exercises for neck pain: A Delphi survey.

PURPOSE: The current context of the COVID-19 pandemic has demonstrated the need for home exercise strategies for the relief of neck pain, which, in recent times, has increased. However, there is a gap regarding home exercises that are aimed at reducing neck pain. Therefore, the aim of this study was to develop, validate and culturally adapt a home exercise protocol for neck pain. METHODS: This was an observational study conducted in three stages: (1) Developing an online search of databases for articles on neck pain exercises. (2) Validating a panel of 12 physical therapists, using the Delphi technique, and (3) Cultural adaptation, through face-to-face assessment with individuals aged 18-30 years with neck pain (n = 15). This resulted in the production of a final version of the protocol. Consensus on the protocol items (using the five-point Likert scale) was considered when the percent agreement was equal to or greater than 75%. Individuals were also asked about pain intensity during the last week before and after performing the protocol. RESULTS: A protocol was developed with the principles of neck and scapular stabilization and upper limb movements, for a period of 4 weeks. Nine physical therapists completed two rounds online, and all items in the second version of the protocol presented an agreement of over 75%. The protocol was culturally adapted by the target population, in which 73% of individuals presented pain reduction with a minimally clinically important difference. CONCLUSION: A 4-week home exercise protocol was created based on the best evidence in the literature, was validated by physical therapists and adapted for the population with neck pain. It proved to be an understandable, useful, practical and convenient tool in the treatment of this disorder and demonstrated an improvement in neck pain. CLINICALTRIALS: GOV: (NCT04187001).

The accuracy of computerized biophotogrammetry in diagnosing changes in the cervical spine and its reliability for the cervical lordosis angle.

BACKGROUND: Accuracy studies of biophotogrammetry protocols require standardization similar to radiography. OBJECTIVE: To estimate the diagnostic accuracy of a biophotogrammetric assessment protocol for cervical hyperlordosis, compared to radiography, and its intra- and inter-examiner reliability for measuring the cervical lordosis angle. METHODS: A study of diagnostic accuracy in women complaining of cervical pain. Two photos were taken using the CorelDraw biophotogrammetric protocol and one radiograph using the Cobb C1-C7 method. The Intra- and Inter-examiner reliability was calculated using the Kappa index and the intraclass correlation coefficient (ICC). The Bland-Altman plot and the ROC curve were presented. RESULTS: The sample consisted of 19 women. The accuracy of biophotogrammetry was 94.73% and the reliability between biophotogrammetry and radiography presented an ICC of 0.84 and a Kappa of 0.87. The excellent intra (ICC = 0.94) and inter-examiner (ICC = 0.86) reliability of the biophotogrammetry was confirmed. The area under the ROC curve was 93.5%. The Bland-Altman plot indicated differences between the two instruments close to the mean (1.5∘). CONCLUSION: The biophotogrammetric protocol proved to be accurate in diagnosing cervical hyperlordosis, with excellent reliability between the biophotogrammetric and radiographic assessments. It also demonstrated excellent intra- and inter-examiner reliability in measuring the cervical lordosis angle.

Impact of Donor Age on the Osteogenic Supportive Capacity of Mesenchymal Stromal Cell-Derived Extracellular Matrix.

Mesenchymal stromal cells (MSC) have been proposed as an emerging cell-based therapeutic option for regenerative medicine applications as these cells can promote tissue and organ repair. In particular, MSC have been applied for the treatment of bone fractures. However, the healing capacity of these fractures is often compromised by patient's age. Therefore, considering the use of autologous MSC, we evaluated the impact of donor age on the osteogenic potential of bone marrow (BM)-derived MSC. MSC from older patients (60 and 80 years old) demonstrated impaired proliferative and osteogenic capacities compared to MSC isolated from younger patients (30 and 45 years old), suggesting that aging potentially changes the quantity and quality of MSC. Moreover, in this study, we investigated the capacity of the microenvironment [i.e., extracellular matrix (ECM)] to rescue the impaired proliferative and osteogenic potential of aged MSC. In this context, we aimed to understand if BM MSC features could be modulated by exposure to an ECM derived from cells obtained from young or old donors. When aged MSC were cultured on decellularized ECM derived from young MSC, their in vitro proliferative and osteogenic capacities were enhanced, which did not happen when cultured on old ECM. Our results suggest that the microenvironment, specifically the ECM, plays a crucial role in the quality (assessed in terms of osteogenic differentiation capacity) and quantity of MSC. Specifically, the aging of ECM is determinant of osteogenic differentiation of MSC. In fact, old MSC maintained on a young ECM produced higher amounts of extracellularly deposited calcium (9.10 ± 0.22 vs. 4.69 ± 1.41 µg.µl-1.10-7 cells for young ECM and old ECM, respectively) and up-regulated the expression of osteogenic gene markers such as Runx2 and OPN. Cell rejuvenation by exposure to a functional ECM might be a valuable clinical strategy to overcome the age-related decline in the osteogenic potential of MSC by recapitulating a younger microenvironment, attenuating the effects of aging on the stem cell niche. Overall, this study provides new insights on the osteogenic potential of MSC during aging and opens new possibilities for developing clinical strategies for elderly patients with limited bone formation capacity who currently lack effective treatments.

Baru (Dipteryx alata Vogel), a woody species characteristic of Cerrado and its phytoremediation potential.

Baru (Dipteryx alata Vogel) is a native tree plant, widely distributed in Brazil, and has a growth and development in acidic soils like Cerrado, indicating a probable tolerance to adverse soil conditions, such as the high concentration of metals and the acidic pH. Due to the lack of information about the tolerance of this species to metals and the possibility of being used in the recovery of degraded areas and/or in phytoremediation, this work was developed with the objective of evaluating the in vitro germination and growth capacity of baru in medium supplemented with different concentrations of aluminum, iron, and manganese, as well as through chemical analysis, to determine the concentration of metals accumulated in cultivated plants in these conditions. The treatments consisted in different concentrations of metals: aluminum, Al3+ (0, 3.5, 7.0, 10.5, 21.0, or 42.0 mg L-1); iron, Fe3+ (0, 2.5, 4.9, 7.4, 14.7, or 29.4 mg L-1); and manganese, Mn2+ (0, 0.4, 0.8, 1.2, 2.4, or 4.8 mg L-1) added to the medium WPM. The tested values were based on using the lower concentration as the limit value, calculated based on risk to human health in accordance with CONAMA resolution 420/2009 for groundwater. At 60 days of cultivation, the percentage of germination, the average number of leaves, the length of the main root and the aerial part, the fresh and dry mass of the aerial part and the root system and the cations concentration Al3+, Fe3+ and Mn2+ in the plant biomass, were evaluated. The results showed that under the conditions in which the experiment was conducted, germination and in vitro growth of baru were not affected by the presence in high concentrations of any of the evaluated metals, with no differences in the percentage of germination and plant growth, as well as typical toxicity characteristics were not observed, such as changes in root morphology, chlorosis, or tissue oxidation. The absence of toxicity symptoms in baru plants, in the presence of Al3+, Fe3+, and Mn2+, indicate that the species is tolerant to these metals. The accumulation of Al3+ and Fe3+ in the plant biomass at the beginning of growth, simultaneously with the increase in the concentrations of these elements in the culture medium, indicates that this species can be used for phytoremediation, because it is a probable accumulator of these elements throughout its development, given the presence in significant concentrations of these elements also in the seeds.

T3 as predictor of mortality in any cause non-critically ill patients.

BACKGROUND: Low T3 syndrome refers to a set of thyroid hormone metabolism alterations present in the disease state. A correlation between low T3 and poor clinical outcomes in the intensive care unit is more established. Nonetheless, studies on non-critically ill patients are few and controversial. OBJECTIVE: To evaluate the prevalence and predictive value of low T3 levels on 30-day and 6-month mortality in non-critically ill patients. Secondary outcomes evaluated the length of hospital stay, overall mortality, and hospital readmission. DESIGN: Prospective cohort study. METHODS: A total of 345 consecutive patients from the Internal Medicine ward of a tertiary hospital in southern Brazil were included and followed from October 2018 to April 2019 (6 months). Levels of total serum T3 were measured weekly, from admission to discharge, and correlated with 30-day and 6-month mortality. RESULTS: Prevalence of low T3 was 36.6%. Low T3 levels were associated with higher 30-day hospital mortality (15.1% vs 4.1%, P < 0.001) and higher 6-month overall mortality (31.7% vs 13.2%, P < 0.001). Total serum T3 at admission was an independent predictor of 30-day hospital mortality. CONCLUSION: Low T3 levels are a prevalent condition among non-critically ill patients, and this condition is associated with poor clinical outcomes in this population. Total serum T3 levels, alone or in association with other predictive scores, were demonstrated to be an easy and valuable tool for risk stratification and should be further employed in this setting.

Synchronous Periampullary Tumors in a Patient With Pancreas Divisum and Neurofibromatosis Type 1.

INTRODUCTION: In this study, we describe for the first time a Neurofibromatosis type 1 patient with pancreas divisum, multiple periampullary tumors and germline pathogenic variants in NF1 and CFTR genes. CASE REPORT: A 62-year-old female NF1 patient presented with weakness, choluria, nausea, and diffuse abdominal pain to an emergency room service. Magnetic resonance imaging revealed an abdominal mass involving the periampullary region and pancreas divisum. After surgical resection, three synchronous neoplasms were detected including two ampullary tumors (adenocarcinoma of the major ampulla and a neuroendocrine tumor of the minor ampulla) and a gastrointestinal stromal tumor (GIST). Germline multigene panel testing (MGPT) identified two pathogenic heterozygous germline variants: NF1 c.838del and CFTR c.1210-34TG[12]T[5]. CONCLUSION: This is the first report of a Neurofibromatosis type 1 patient with pancreas divisum and multiple periampullary tumors harboring pathogenic germline variants in NF1 and CFTR genes. The identification of two germline variants and a developmental anomaly in this patient may explain the unusual and more severe findings and underscores the importance of comprehensive molecular analyses in patients with complex phenotypes.

Ultrasound Assessment of Disease Activity Prevents Disease-Modifying Antirheumatic Drug (DMARD) Escalation and May Reduce DMARD-Related Direct Costs in Rheumatoid Arthritis With Fibromyalgia: An Exploratory Study.

OBJECTIVES: as an objective measure, ultrasound (US) could prevent rheumatoid arthritis (RA) overtreatment induced by concomitant fibromyalgia (FM). Our goal was to study how patients with RA and FM who underwent a US examination differed from those without a US examination in terms of overall disease-modifying antirheumatic drug (DMARD) escalation and biologic DMARD-related direct costs. METHODS: Patients with RA and FM were seen between 2011 and 2017. In cases of 28-joint Disease Activity Score (DAS28) overestimation, patients were referred to undergo a US examination. The US group underwent a US examination to confirm disease activity, and the DAS28 group had disease activity assessment based solely on the DAS28. RESULTS: Of 230 patients with RA, 22 women with RA and FM (DAS28 group, n = 9; and US group, n = 13) were seen in 316 visits (115.68 patient-years). The DMARD treatment was escalated in 27.1% of visits in the DAS28 group versus 17.3% in the US group (P = .046). The relative risk of DMARD escalation in the DAS28 group compared to the US group was 1.57 (95% confidence interval, 1.01-2.43). In sum total, US$240,784.52 were spent on biologics throughout the entire study period. Basing biologic DMARD prescriptions on US results could save an average of US$405.66 per patient-year. CONCLUSIONS: In this real-life study of patients with RA and FM, a US examination was associated with less DMARD escalation and could reduce biologic DMARD direct costs. Specifically, synovitis as scored by power Doppler US could be useful as a treatment target for RA in patients with DAS28 overestimation due to FM, but further studies are necessary.

Building the bridge between healthcare emergency management and daily operations.

Healthcare emergency management continues to suffer from not being part of daily organisational operations. The aim of this paper is to shed light on a new paradigm for healthcare emergency management by viewing it in a distilled way: incidents that negatively affect the environment of care are simply deviations from normal. Doing so simplifies the approach and enables such work to meld more easily into the already complex healthcare clinical, operational and financial environs. Readers will take away knowledge on healthcare emergency management as deviations from normal operations, the goal being to aid in improving understanding and integrating such work into daily operations. The scope of this paper is a descriptive one of healthcare facilities, be they inpatient or outpatient, urban or rural and any combination of each.

Burnout em enfermeiros dos cuidados continuados / Burnout in long-term care nurses

A Síndrome de Burnout é geralmente definida como um conceito multidimensional, caraterizada por uma exaustão emocional elevada, desenvolvimento de atitudes de indiferença e afastamento emocional das pessoas a quem se prestam os serviços e/ ou cuidados e um sentimento de ineficácia. Esta síndrome é mais frequente entre os profissionais que trabalham no seu quotidiano com pessoas, ou seja, entre os profissionais que prestam ajuda e a sua origem, está relacionada com a exposição a uma carga excessiva de stress ocupacional crónico. O objetivo geral para esta investigação é conhecer a existência da Síndrome de Burnout nos enfermeiros que trabalham nas Unidades de Cuidados Continuados (Média Duração e Reabilitação e Longa Duração e Manutenção) da zona Norte do país. Metodologicamente trata-se de um estudo descritivo, quantitativo, de caracter correlacional e de natureza transversal. A população é constituída por 96 enfermeiros que exercem a sua actividade laboral nas unidades de cuidados continuados de média e de longa duração da zona Norte do país. A populaçãoalvo é maioritariamente feminina, com idades compreendidas entre os 22 e os 42 anos. O instrumento de recolha de dados utilizado foi o questionário constituído pela escala de avaliação do Burnout (Maslach Burnout Inventory ­ MBI, 1981) e por questões para caracterização sociodemográfica e profissional da população. A organização e o tratamento estatístico dos dados foram executados pelo programa estatístico SPSS (versão 18). Os resultados obtidos na escala de Maslach Burnout Inventory (MBI), na população em estudo, indicam que em média a mesma apresenta um nível moderado de Burnout com um score de 54,75. Encontramos algumas correlações estatisticamente significativas entre Burnout e as variáveis, idade, género, tempo de serviço e satisfação no trabalho.

Burnout syndrome is generally defined as a multidimensional concept, characterized by a high emotional exhaustion develop attitudes of indifference and emotional distance from the people who provide the services and / or care and a sense of ineffectiveness. This syndrome is more common among professionals who work with people in their daily lives, or among professionals that provide help and their origin is related to exposure to excessive load of chronic occupational stress. The overall objective for this research was to understand and assess the incidence of burnout syndrome in nurses working in Continuing Care Units (Average Duration and Long Term Rehabilitation and Maintenance) in the northern zone of the country. Methodologically this is a descriptive study, quantitative character correlational and cross-sectional nature. The target population is probabilistic and random this simple, being comprised of 96 nurses who are active in the labor units of continuing care and long-term average in the North of the country. The population is mostly female, aged 22 and 42 years. The data collection instrument used was a questionnaire consisting of the evaluation scale of burnout (Maslach Burnout Inventory - MBI, 1981) and questions for socio demographic and occupational sample. The organization and processing of the data were performed by SPSS (version 18). The results on the scale of Maslach Burnout Inventory (MBI), the sample under study, indicate that on average the sample showed a moderate level of burnout with a score of 54,75. We found some statistically significant correlations between burnout and the variables, age, gender, length of service and job satisfaction.

Inflammatory root resorption in primary molars: prevalence and associated factors

This study aimed at determining the prevalence of inflammatory root resorption and associated factors in 1068 primary mandibular molars in 453 children 3 to 12 years of age. Age, dental history and medical history were recorded using a questionnaire administered to the children's parents/caregivers. Previously trained and calibrated examiners assessed radiographic images of the primary molars by direct observation, with the aid of a viewing box. Root resorption (physiological or inflammatory), dental crown status (healthy, carious with no pulp involvement, carious with pulp involvement and evidence of restoration), and pulpotomy or pulpectomy were determined. Data analysis involved descriptive statistics, the chi-square test and a multiple logistic regression (p < 0.05). The prevalence of inflammatory root resorption was 16.2% (n = 173). The male gender (OR: 1.4; 95% CI), the 3-to-7-years age bracket (OR: 1.5; 95% CI), an unhealthy dental crown (OR: 8.7; 95% CI), caries with pulp involvement (OR: 7.4; 95% CI), pulpotomy (OR: 3.1; 95% CI), and pulpectomy (OR: 5.4; 95% CI) were risk factors for the occurrence of inflammatory root resorption in primary molars. In conclusion, the prevalence of inflammatory root resorption in the present sample was 16.2%. Gender, age, an unhealthy tooth, caries with pulp involvement, pulpotomy, pulpectomy, and the absence of a restoration were associated with a higher occurrence of inflammatory root resorption in primary molars.

Inflammatory root resorption in primary molars: prevalence and associated factors.

This study aimed at determining the prevalence of inflammatory root resorption and associated factors in 1068 primary mandibular molars in 453 children 3 to 12 years of age. Age, dental history and medical history were recorded using a questionnaire administered to the children's parents/caregivers. Previously trained and calibrated examiners assessed radiographic images of the primary molars by direct observation, with the aid of a viewing box. Root resorption (physiological or inflammatory), dental crown status (healthy, carious with no pulp involvement, carious with pulp involvement and evidence of restoration), and pulpotomy or pulpectomy were determined. Data analysis involved descriptive statistics, the chi-square test and a multiple logistic regression (p < 0.05). The prevalence of inflammatory root resorption was 16.2% (n = 173). The male gender (OR: 1.4; 95% CI), the 3-to-7-years age bracket (OR: 1.5; 95% CI), an unhealthy dental crown (OR: 8.7; 95% CI), caries with pulp involvement (OR: 7.4; 95% CI), pulpotomy (OR: 3.1; 95% CI), and pulpectomy (OR: 5.4; 95% CI) were risk factors for the occurrence of inflammatory root resorption in primary molars. In conclusion, the prevalence of inflammatory root resorption in the present sample was 16.2%. Gender, age, an unhealthy tooth, caries with pulp involvement, pulpotomy, pulpectomy, and the absence of a restoration were associated with a higher occurrence of inflammatory root resorption in primary molars.

Competências e habilidades para pesquisa em alunos de graduação de terapia ocupacional / Research competence and ability among graduating students in occupational therapy

Com o objetivo de identificar a percepção de alunos concluintes do curso de Terapia Ocupacional da Universidade do Estado do Pará sobre as competências e habilidades investigativas nas atividades de pesquisa na graduação, foram consultados 46 discentes do 4.º e do 5.º anos do curso, que responderam a dois questionários com perguntas abertas e fechadas. Os dados apontam aspectos importantes para uma reflexão sobre as diretrizes implementadas no projeto pedagógico do curso e a inserção do aluno na pesquisa durante a elaboração do Trabalho de Conclusão de Curso. Os dados revelam que as habilidades investigativas relacionadas com o planejamento, o processo da investigação e a redação do texto final da pesquisa encontram-se pouco desenvolvidas. Os dados indicam ainda que muitas ações são necessárias para a efetivação da pesquisa na graduação, como o desenvolvimento de uma cultura de pesquisa dentro da universidade, o acesso às referências bibliográficas atualizadas e à Internet, a capacitação docente, a sistematização do processo ensino-aprendizagem e a participação ativa dos alunos e de toda a comunidade acadêmica(AU)

This investigation sought to identify the perception of students concluding the course in occupation therapy at the State University of Para regarding research competence and ability. A questionnaire, composed of open and closed questions was administered to 46 concluding students (fourth and fifth year). The data pointed out important aspects related to directives implemented in a pedagogic project, containing criteria for the final course thesis. Finding revealed that research abilities related to investigative planning, procedures, and text preparation were poorly developed. The data also showed that many ingredients were considered necessary for effective training in research design. Among others, the development of a "research culture", access to current bibliography and the internet, capable teaching, a systematic teaching-learning process, and the active participation of students in the academic community(AU)

Competências e habilidades para pesquisa em alunos de graduação de terapia ocupacional / Research competence and ability among graduating students in occupational therapy

Com o objetivo de identificar a percepção de alunos concluintes do curso de Terapia Ocupacional da Universidade Estadual do Pará sobre as competências e habilidades investigativas nas atividades de pesquisa na graduação, foram consultados 46 discentes do 4.º e do 5.º anos do curso, que responderam a dois questionários com perguntas abertas e fechadas. Os dados apontam aspectos importantes para uma reflexão sobre as diretrizes implementadas no projeto pedagógico do curso e a inserção do aluno na pesquisa durante a elaboração do Trabalho de Conclusão de Curso. Os dados revelam que as habilidades investigativas relacionadas com o planejamento, o processo da investigação e a redação do texto final da pesquisa encontram-se pouco desenvolvidas. Os dados indicam ainda que muitas ações são necessárias para a efetivação da pesquisa na graduação, como o desenvolvimento de uma cultura de pesquisa dentro da universidade, o acesso às referências bibliográficas atualizadas e à Internet, a capacitação docente, a sistematização do processo ensino-aprendizagem e a participação ativa dos alunos e de toda a comunidade acadêmica.

Prospective study of quality of life of patients receiving treatment for prostate cancer.

BACKGROUND: No research was found that compared quality of life (QOL) outcomes of prostate cancer patients receiving intensity-modulated radiation therapies with prostate cancer patients receiving radical prostatectomy. OBJECTIVES: To (a) describe differences in QOL before and after three types of treatment for prostate cancer: radical prostatectomy, intensity-modulated radiation therapy + seed implantation (permanent brachytherapy), or intensity-modulated radiation therapy + high dose rate radiotherapy (temporary brachytherapy); and (b) investigate demographic, physical, and psychosocial variables that impact QOL of men with prostate cancer. METHODS: Data were collected on three occasions: baseline (prior to treatment), 1 month, and 3 months after beginning treatment. Measures included biographic data, physiological, and psychological measures. Analysis of variance and hierarchical regression were used to examine patterns, describe differences, and identify predictors of QOL in the three treatment groups. QOL was conceptualized as a multidimensional construct that included physical, psychological, social, and functional well-being and prostate cancer concerns. RESULTS: Groups differed significantly in bowel and urinary symptom scores and prostate cancer concerns at baseline, and in urinary and depressive symptoms at 3 months. There were no significant group differences at 1 month. DISCUSSION: Significant differences were found in QOL as measured with the Functional Assessment of Cancer Treatment-Prostate after treatment with radical prostatectomy, intensity-modulated radiation therapy + seed implantation, or intensity-modulated radiation therapy + high dose rate radiotherapy. Findings may provide healthcare providers with knowledge about treatment sequelae for prostate cancer, enable healthcare providers to educate patients about QOL outcomes of treatment for prostate cancer, and enable patients to make more informed treatment decisions.