Family Members, Transplantation Candidates, and Patients Who Underwent Liver Transplantation Had Insufficient Information About the Procedure.

INTRODUCTION: Adherence to treatment is essential for a successful liver transplantation (LT) because LT requires information, abilities, and competencies of patients and family members. OBJECTIVES: This study sought to identify whether the information received about the LT process was enough for either patients or family members who attended a liver transplant center in a school hospital. METHODS: This was a transversal study using questionnaires to verify received information on LT. It included 50 patients on the waiting list for LT, 50 transplanted patients, and 50 family members. RESULTS: There was a prevalence of men (82%) among patients, age range from 19 to 67 years (average: 46.87 ± 10.99), and of women (74%) among family members, age range from 18 to 80 years (average: 43.5 ± 11.77). The majority of subjects (88%) had a low education level. The most frequent etiology of hepatic cirrhosis was viral hepatitis associated with alcohol. A significant number of the listed and transplanted patients as well as all family members reported insufficient information about the process of the transplantation. The kind of insufficient information varied according to the period of treatment. The best way to obtain information, as reported by patients and family members, was a combination of oral and written information. CONCLUSIONS: Our data show the need for improvement in the means of delivering information to patients and family members, and an explanatory manual was created from this study.

Families who previously refused organ donation would agree to donate in a new situation: a cross-sectional study.

BACKGROUND: The limited supply of organs restricts the number of transplantations. Studying the families who refuse donation may help to increase the number of transplantations. METHODS: This descriptive cross-sectional study used a questionnaire to obtain information from 61 family members who had refused to donate organs from January 1997 to December 2004. The exclusion criterion was donor death less than 1 year from the study. The mean age of subjects was 41 ± 12.7 years (range, 18 to 79 years) with 66% women. RESULTS: More than half (36 of 69; 52%) of the families who refused donation would agree to donate in a new situation. The primary reasons for refusing donation were: disagreement among family members (25 of 128; 19%), lack of knowledge regarding the deceased's wishes (22 of 128; 17%), and previous request from the deceased not to be a donor (17 of 128; 13%). The most frequent suggestions to increase organ donation were to provide families with more information (43 of 149; 29%), initiate contact among the families (36 of 149; 24%), and involve a trusted physician (30 of 149; 20%). CONCLUSION: Most family members who refused organ donation changed their minds and would agree to donate in a few situation. Most of the reasons for refusing to donate reflected a lack of information and discussion on the topic.

Patients undergoing liver transplantation: psychosocial characteristics, depressive symptoms, and quality of life.

BACKGROUND: Liver transplantation is the treatment of choice for patients with end-stage liver diseases to improve social rehabilitation and quality of life. Our objective was to evaluate the psychosocial characteristics, depressive symptoms, and quality of life among patients undergoing liver transplantation. MATERIALS AND METHODS: Patients underwent individual assessments using a semidirected interview. Beck's Depression Inventory and SF-36 Quality of Life Questionnaire. The signal test was used with a significance level set at .05. RESULTS: The characteristics of the sample (n = 30) were compatible with literature data for gender (n = 20 men), age (mean age, 51.96 years), education (elementary and middle school), and etiology (viral hepatitis). A significant number of patients were not able to maintain their professional activities: prior to transplantation (n = 18) and after transplantation (n = 13) due to the adverse effects of immunosuppressants (n = 9). The analysis indicated a significant quality of life improvement after transplantation for the following domains: functional capacity (P = .047), physical aspects (P = .024), pain (P = .001), overall health status (P = .003), and social aspects (P = .021). Significant depressive symptoms (n = 6) were experienced before and after the surgery. CONCLUSIONS: The data indicated a significant quality of life improvement after liver transplantation. Occupational activity and surgery time had a positive influence on these results. The frequency of depressive symptoms was similar before and after transplantation, correlating with less favorable quality of life scores. The results indicated the need to provide regular psychosocial assessment and follow-up in all stages of therapy.

[Epidemiological research on dementia in developing countries]. / Investigações epidemiológicas sobre demência nos países em desenvolvimento.

As the world population is ageing, dementia becomes an important public health problem, particularly in developing countries. Epidemiological research in these settings is scarce and present additional methodological difficulties, mainly regarding the socio-cultural adequacy of instruments used to identify cases of dementia. As a result of these concerns the 10/66 Dementia Research Group was founded to fill this gap. This is an international network of investigators, mostly from developing countries, and the group's name was based on the paradox that less than 10% of the population-based studies on dementia are directed to 2/3 or more cases of people with dementia living in developing countries. The aim of the paper is to update data in the literature regarding the differences in dementia prevalence and incidence seen in developed and developing countries.

Investigaçöes epidemiológicas sobre demência nos países em desenvolvimento / Epidemiological research on dementia in developing countries

Na medida em que a populaçäo mundial está envelhecendo, a demência está se constituindo em importante problema de saúde pública, particularmente nos países em desenvolvimento. Investigaçöes epidemiológicas nestes países säo escassas e apresentam dificuldades metodológicas adicionais, principalmente no que se refere à adequaçäo sociocultural dos instrumentos utilizados para a definiçäo de casos. Tendo em vista estas preocupaçöes, foi fundado o "Grupo de Pesquisa em Demência 10/66", que é constituído por uma rede internacional de pesquisadores, predominantemente de países em desenvolvimento. O nome do grupo tem como referência o paradoxo de que menos de 10 por cento dos estudos populacionais sobre demência säo dirigidos aos 2/3 ou mais de casos de pessoas com demência que vivem em países em desenvolvimento. O objetivo do artigo é atualizar informaçöes da literatura sobre as diferenças de prevalência e incidência de demência encontradas em países desenvolvidos e em desenvolvimento