Factors associated with hepatitis C treatment adherence: an integrative review. / Fatores associados à adesão ao tratamento da hepatite C: revisão integrativa.

This integrative review examined factors associated with hepatitis C treatment adherence. The articles included were published in English, Spanish and Portuguese in the Lilacs, Medline, PsycINFO, Web of Science, Scopus and CINAHL databases, between 2000 and 2019. Initially, 540 publications were found and, after applying the study inclusion criteria, 22 articles were selected. Percentage non-adherence to treatment ranged from 12% to 32%. The variables identified as facilitating adherence were: receiving treatment for psychiatric disorders identified during treatment; knowing about medications and disease; receiving less complex treatment with greater likelihood of cure; fewer adverse events; social support; doctor-patient communication; and/or being in relationships. Barriers to adherence identified were: presence of depressive symptoms and other mental disorders; abuse of alcohol and psychoactive substances; education; age; ethnicity; unemployment; not having a steady partner; stigma; distance from health services; and the complexity and adverse effects of treatment. This review identified gaps in research on adherence.

Esta revisão integrativa propôs-se a analisar na literatura da área estudos sobre fatores associados à adesão ao tratamento da hepatite C. Foram pesquisados artigos, publicados em inglês, espanhol e português, nas bases de dados Lilacs, Medline, PsycINFO, Web of Science, Scopus e CINAHL, entre os anos 2000 a 2019. Foram obtidas, inicialmente, 540 publicações e, posteriormente, aplicando-se os critérios de inclusão estabelecidos, foram selecionados 22 artigos. Constatou-se nos artigos analisados que a porcentagem de não adesão ao tratamento variou de 12% a 32%. Foram identificados como facilitadores da adesão: receber tratamento para transtornos psiquiátricos identificados durante o tratamento, ter conhecimento sobre os medicamentos e doença, receber tratamento menos complexo e com maior possibilidade de cura, apresentar menor número de eventos adversos, ter apoio social e bom vínculo com o médico. Foram identificadas como barreiras à adesão: presença de sintomas depressivos e de outros transtornos mentais, uso abusivo de álcool e substâncias psicoativas, baixa escolaridade, idade (ser mais jovem); etnia (afro-americanos), desemprego, não ter parceiro fixo, relatar estigma, distância do serviço de saúde, complexidade e eventos adversos do tratamento. Foram também identificadas lacunas nas pesquisas sobre adesão.

Fatores associados à adesão ao tratamento da hepatite C: revisão integrativa / Factors associated with hepatitis C treatment adherence: an integrative review

Resumo Esta revisão integrativa propôs-se a analisar na literatura da área estudos sobre fatores associados à adesão ao tratamento da hepatite C. Foram pesquisados artigos, publicados em inglês, espanhol e português, nas bases de dados Lilacs, Medline, PsycINFO, Web of Science, Scopus e CINAHL, entre os anos 2000 a 2019. Foram obtidas, inicialmente, 540 publicações e, posteriormente, aplicando-se os critérios de inclusão estabelecidos, foram selecionados 22 artigos. Constatou-se nos artigos analisados que a porcentagem de não adesão ao tratamento variou de 12% a 32%. Foram identificados como facilitadores da adesão: receber tratamento para transtornos psiquiátricos identificados durante o tratamento, ter conhecimento sobre os medicamentos e doença, receber tratamento menos complexo e com maior possibilidade de cura, apresentar menor número de eventos adversos, ter apoio social e bom vínculo com o médico. Foram identificadas como barreiras à adesão: presença de sintomas depressivos e de outros transtornos mentais, uso abusivo de álcool e substâncias psicoativas, baixa escolaridade, idade (ser mais jovem); etnia (afro-americanos), desemprego, não ter parceiro fixo, relatar estigma, distância do serviço de saúde, complexidade e eventos adversos do tratamento. Foram também identificadas lacunas nas pesquisas sobre adesão.

Abstract This integrative review examined factors associated with hepatitis C treatment adherence. The articles included were published in English, Spanish and Portuguese in the Lilacs, Medline, PsycINFO, Web of Science, Scopus and CINAHL databases, between 2000 and 2019. Initially, 540 publications were found and, after applying the study inclusion criteria, 22 articles were selected. Percentage non-adherence to treatment ranged from 12% to 32%. The variables identified as facilitating adherence were: receiving treatment for psychiatric disorders identified during treatment; knowing about medications and disease; receiving less complex treatment with greater likelihood of cure; fewer adverse events; social support; doctor-patient communication; and/or being in relationships. Barriers to adherence identified were: presence of depressive symptoms and other mental disorders; abuse of alcohol and psychoactive substances; education; age; ethnicity; unemployment; not having a steady partner; stigma; distance from health services; and the complexity and adverse effects of treatment. This review identified gaps in research on adherence.

[Integrative review: psychological distress among university students and correlated factors]. / Revisão integrativa: sofrimento psíquico em estudantes universitários e fatores associados.

This review sought to identify risk factors and protection from psychic distress among university students. Empirical studies were analyzed in the Web of Science, Medline and Scopus databases. A total of 1,375 articles were located, and after the exclusion criteria were applied, 37 articles made up the final sample, most of which were cross-sectional studies published in the last five years, in developed countries and with students in the health area. The most frequently used instruments for psychic distress screening were the General Health Questionnaire and the Self Reporting Questionnaire, which identified a prevalence of between 18.5% and 49.1% and, as risk factors, conditions related to academic life (24) and to health (22). Twelve studies identified as protective factors: given coping strategies, sense of coherence, self-efficacy, vigor, self-esteem, resilience, among other psychological conditions. This review singles out directions for possible interventions that could contribute to the well-being of students and to stimulate more positive experiences in the educational environment.

Esta revisão propôs-se a identificar fatores de risco e proteção para sofrimento psíquico em estudantes universitários. Analisaram-se estudos empíricos nas bases de dados: Web of Science, Medline e Scopus. Foram localizados 1375 artigos e, aplicados os critérios de exclusão, 37 artigos compuseram a amostra final, tendo sido a maioria estudos transversais, publicados nos últimos cinco anos, em países desenvolvidos, com estudantes da área da saúde. Os instrumentos mais utilizados para o rastreamento de sofrimento psíquico foram o General Health Questionnaire e o Self Reporting Questionnarie, que identificaram prevalências de 18,5% a 49,1% e, como fatores de risco, condições relativas à vida acadêmica (24) e à saúde (22). Foram identificadas como fatores de proteção, em doze estudos, apresentar determinadas estratégias de coping, senso de coerência, autoeficácia, vigor, autoestima, resiliência, entre outras condições psicológicas. Essa revisão aponta direções para possíveis intervenções que poderiam contribuir para o bem estar dos estudantes e para estimular vivências mais positivas no ambiente educacional.

Revisão integrativa: sofrimento psíquico em estudantes universitários e fatores associados / Integrative review: psychological distress among university students and correlated factors

Resumo Esta revisão propôs-se a identificar fatores de risco e proteção para sofrimento psíquico em estudantes universitários. Analisaram-se estudos empíricos nas bases de dados: Web of Science, Medline e Scopus. Foram localizados 1375 artigos e, aplicados os critérios de exclusão, 37 artigos compuseram a amostra final, tendo sido a maioria estudos transversais, publicados nos últimos cinco anos, em países desenvolvidos, com estudantes da área da saúde. Os instrumentos mais utilizados para o rastreamento de sofrimento psíquico foram o General Health Questionnaire e o Self Reporting Questionnarie, que identificaram prevalências de 18,5% a 49,1% e, como fatores de risco, condições relativas à vida acadêmica (24) e à saúde (22). Foram identificadas como fatores de proteção, em doze estudos, apresentar determinadas estratégias de coping, senso de coerência, autoeficácia, vigor, autoestima, resiliência, entre outras condições psicológicas. Essa revisão aponta direções para possíveis intervenções que poderiam contribuir para o bem estar dos estudantes e para estimular vivências mais positivas no ambiente educacional.

Abstract This review sought to identify risk factors and protection from psychic distress among university students. Empirical studies were analyzed in the Web of Science, Medline and Scopus databases. A total of 1,375 articles were located, and after the exclusion criteria were applied, 37 articles made up the final sample, most of which were cross-sectional studies published in the last five years, in developed countries and with students in the health area. The most frequently used instruments for psychic distress screening were the General Health Questionnaire and the Self Reporting Questionnaire, which identified a prevalence of between 18.5% and 49.1% and, as risk factors, conditions related to academic life (24) and to health (22). Twelve studies identified as protective factors: given coping strategies, sense of coherence, self-efficacy, vigor, self-esteem, resilience, among other psychological conditions. This review singles out directions for possible interventions that could contribute to the well-being of students and to stimulate more positive experiences in the educational environment.

Depressive symptoms among the elderly in São Paulo city, Brazil: prevalence and associated factors (SABE Study). / Sintomas depressivos em idosos do município de São Paulo, Brasil: prevalência e fatores associados (Estudo SABE).

OBJECTIVE: To estimate the prevalence of depressive symptoms in the elderly in São Paulo city, Brazil (SABE Study), in 2006 and to identify risk factors associated with the 2006 prevalence and protective factors among those who did not have depressive symptoms in the assessments conducted in 2000 and 2006. METHODS: In this cross-sectional and longitudinal study, the Geriatric Depression Scale was used for inclusion in the cohort in 2000 and also in 2006. RESULTS: The prevalence of depressive symptoms in 2006 was 14.2% (95%CI 11.8 - 16.7), and 74.8% of the participants did not present depressive symptoms in 2000 neither in 2006. Logistic regression models were constructed, with different groups of variables (socio-demographic variables, status and perception of health and memory) adjusted for sex and age. In the final logistic regression model, the following factors were associated with depressive symptoms: self-assessment of vision, oral health, memory and of general health as poor, dependence for basic activities of daily living, and moderate or severe family dysfunction. Protective factors against presenting depressive symptoms in the 2000 and 2006 phases were: being male, absence of pulmonary disease and positive self-assessment of health. CONCLUSION: Depressive symptoms were frequent among the elderly, and were associated with health problems, dependence and family dysfunction. These factors should be addressed in health policy planning for the care of these elderly.

OBJETIVO: Estimar a prevalência de sintomas depressivos em idosos do município de São Paulo, Brasil (Estudo SABE), em 2006 e identificar fatores de risco associados a essa prevalência em 2006 e fatores de proteção entre os idosos que não apresentaram sintomas depressivos nas avaliações realizadas em 2000 e 2006. MÉTODOS: Estudo transversal e longitudinal que utilizou a Escala de Depressão Geriátrica na inclusão da coorte em 2000 e em 2006. RESULTADOS: A prevalência de sintomas depressivos em 2006 foi de 14,2% (IC95% 11,8 - 16,7) e 74,8% dos participantes não apresentaram sintomas depressivos em 2000 nem em 2006. Foram construídos modelos de regressão logística, tendo como exposição diferentes grupos de variáveis (sociodemográficas; condições e percepção de saúde e memória) ajustando-se para sexo e idade. No modelo final da regressão logística, associaram-se a sintomas depressivos: autoavaliação da visão, da saúde bucal, da memória e da saúde geral como ruins, dependência para atividades básicas de vida diária e disfunção familiar moderada ou grave. Os fatores de proteção para não ter apresentado sintomas depressivos nas fases de 2000 e 2006 foram: sexo masculino, não referir doença pulmonar e avaliar positivamente a saúde. CONCLUSÃO: Sintomas depressivos nos idosos estudados foram frequentes e se associaram com piores condições de saúde, dependência e disfunção familiar e tais fatores devem ser considerados no planejamento de políticas de saúde para prestação de cuidados a esses idosos.

Sintomas depressivos em idosos do município de São Paulo, Brasil: prevalência e fatores associados (Estudo SABE) / Depressive symptoms among the elderly in São Paulo city, Brazil: prevalence and associated factors (SABE Study)

RESUMO: Objetivo: Estimar a prevalência de sintomas depressivos em idosos do município de São Paulo, Brasil (Estudo SABE), em 2006 e identificar fatores de risco associados a essa prevalência em 2006 e fatores de proteção entre os idosos que não apresentaram sintomas depressivos nas avaliações realizadas em 2000 e 2006. Métodos: Estudo transversal e longitudinal que utilizou a Escala de Depressão Geriátrica na inclusão da coorte em 2000 e em 2006. Resultados: A prevalência de sintomas depressivos em 2006 foi de 14,2% (IC95% 11,8 - 16,7) e 74,8% dos participantes não apresentaram sintomas depressivos em 2000 nem em 2006. Foram construídos modelos de regressão logística, tendo como exposição diferentes grupos de variáveis (sociodemográficas; condições e percepção de saúde e memória) ajustando-se para sexo e idade. No modelo final da regressão logística, associaram-se a sintomas depressivos: autoavaliação da visão, da saúde bucal, da memória e da saúde geral como ruins, dependência para atividades básicas de vida diária e disfunção familiar moderada ou grave. Os fatores de proteção para não ter apresentado sintomas depressivos nas fases de 2000 e 2006 foram: sexo masculino, não referir doença pulmonar e avaliar positivamente a saúde. Conclusão: Sintomas depressivos nos idosos estudados foram frequentes e se associaram com piores condições de saúde, dependência e disfunção familiar e tais fatores devem ser considerados no planejamento de políticas de saúde para prestação de cuidados a esses idosos.

ABSTRACT: Objective: To estimate the prevalence of depressive symptoms in the elderly in São Paulo city, Brazil (SABE Study), in 2006 and to identify risk factors associated with the 2006 prevalence and protective factors among those who did not have depressive symptoms in the assessments conducted in 2000 and 2006. Methods: In this cross-sectional and longitudinal study, the Geriatric Depression Scale was used for inclusion in the cohort in 2000 and also in 2006. Results: The prevalence of depressive symptoms in 2006 was 14.2% (95%CI 11.8 - 16.7), and 74.8% of the participants did not present depressive symptoms in 2000 neither in 2006. Logistic regression models were constructed, with different groups of variables (socio-demographic variables, status and perception of health and memory) adjusted for sex and age. In the final logistic regression model, the following factors were associated with depressive symptoms: self-assessment of vision, oral health, memory and of general health as poor, dependence for basic activities of daily living, and moderate or severe family dysfunction. Protective factors against presenting depressive symptoms in the 2000 and 2006 phases were: being male, absence of pulmonary disease and positive self-assessment of health. Conclusion: Depressive symptoms were frequent among the elderly, and were associated with health problems, dependence and family dysfunction. These factors should be addressed in health policy planning for the care of these elderly.

Correlates of above-average cognitive performance among older adults: the SABE study.

This study aimed to identify factors associated with optimal global cognitive performance among older adults in the city of Sao Paulo, Brazil. A cross-sectional study was carried out with a sample of community-dwelling older adults who participated in the SABE Study (Health, Well-Being and Ageing) in 2006. The dependent variable was cognitive performance, categorized as "normal" or "optimal". The independent variables were socio-demographic data, lifestyle and health conditions. Data analysis involved descriptive statistics, followed by multiple logistic regression (significance set at 5%). Optimal cognitive performance was found in 28.4% of the sample, representing 730,051 older adults. Optimal performance was associated with a younger age, a report of no difficulties regarding instrumental activities of daily living, non-abusive alcohol intake, self-rated income sufficient to meet one's daily needs and contact with family and friends. Optimal cognitive performance among older adults is associated with conditions favoring participation and independence.

Correlates of above-average cognitive performance among older adults: the SABE study / Fatores de desempenho cognitivo acima da média em idosos: Estudo SABE / Factores de rendimiento cognitivo superior a la media en personas de edad avanzada: estudio SABE

This study aimed to identify factors associated with optimal global cognitive performance among older adults in the city of Sao Paulo, Brazil. A cross-sectional study was carried out with a sample of community-dwelling older adults who participated in the SABE Study (Health, Well-Being and Ageing) in 2006. The dependent variable was cognitive performance, categorized as “normal” or “optimal”. The independent variables were socio-demographic data, lifestyle and health conditions. Data analysis involved descriptive statistics, followed by multiple logistic regression (significance set at 5%). Optimal cognitive performance was found in 28.4% of the sample, representing 730,051 older adults. Optimal performance was associated with a younger age, a report of no difficulties regarding instrumental activities of daily living, non-abusive alcohol intake, self-rated income sufficient to meet one’s daily needs and contact with family and friends. Optimal cognitive performance among older adults is associated with conditions favoring participation and independence.

O estudo objetivou identificar os fatores associados ao melhor desempenho cognitivo global em idosos do Município de São Paulo, Brasil. O estudo foi transversal com uma amostra composta por idosos não institucionalizados que participaram do Estudo Saúde, Bem-Estar e Envelhecimento (SABE) de 2006. A variável dependente foi o declínio cognitivo categorizado em: desempenho normal e melhor. As variáveis independentes incluíram condições sociodemográficas, estilo de vida e saúde. Realizou-se análise descritiva seguida de regressão logística múltipla, considerando-se um nível de significância de 5%. Desempenho acima da média foi observado em 28,4% da amostra, equivalente a 730.051 idosos. Idosos mais jovens; sem dificuldades nas atividades instrumentais de vida diária; com consumo não abusivo de álcool; autopercepção da renda como suficiente para atender as necessidades diárias e com contato social com familiares e amigos apresentaram mais chances de apresentarem melhor desempenho cognitivo acima da média. Conclui-se que desempenho cognitivo está associado à condições favoráveis de participação e independência.

Este estudio tuvo el objetivo identificar los factores asociados con el rendimiento cognitivo global óptimo entre ancianos de São Paulo, Brasil. Este fue un estudio transversal con una muestra de ancianos no institucionalizados que participaron del Estudio Salud, Bienestar y Envejecimiento (SABE) en 2006. La variable dependiente fue el rendimiento cognitivo, clasificado como “normal” o “óptimo”. Las variables independientes fueron: datos sociodemográficos, estilo de vida y condiciones de salud. Rendimiento cognitivo encima de la média se encontró en un 28,4%, lo que representa 730.051 adultos mayores. El rendimiento encima de la média se asoció a una edad más temprana, ausencia de dificultad en las actividades instrumentales de la vida diaria, el consumo no abusivo de alcohol, el relato de ingresos suficientes para satisfacer las necesidades diarias y el contacto con amigos y familiares. El rendimiento cognitivo óptimo entre los adultos mayores se asoció con condiciones que favorecen la participación y la independencia.

Social support and common mental disorder among medical students.

INTRODUCTION: Different kinds of psychological distress have been identified for students in the health field, especially in the medical school. OBJECTIVE: To estimate the prevalence of mental suffering among medical students in the Southeastern Brazil and asses its association with social support. METHODS: It is a cross-sectional study. Structured questionnaires were applied for students from the 1st up to the 6th years of the medical school of Universidade Estadual Paulista "Júlio de Mesquita Filho", assessing demographic variables related to aspects of graduation and adaptation to the city. Psychological suffering was defined as a common mental disorder (CMD) assessed by the Self Reporting Questionnaire (SRQ-20). Social support was assessed by the social support scale of the Medical Outcomes Study (MOS). The association between the outcome and explanatory variables was assessed by the χ2 test and Logistic Regression, for the multivariate analyses, using p < 0.05. RESULTS: The response rate was of 80.7%, with no differences between sample and the population regarding gender (p = 0.78). The average age was 22 years old (standard deviation - SD = 2.2), mainly women (58.2%) and students who were living with friends (62%). The prevalence of CMD was 44.9% (95%CI 40.2 - 49.6). After the multivariate analyses, the explanatory variables that were associated with CMD were: feeling rejected in the past year (p < 0.001), thinking about leaving medical school (p < 0.001) and "interaction" in the MOS scale (p = 0.002). CONCLUSIONS: The prevalence of CMD among medical students was high and insufficient social support was an important risk factor. Our findings suggest that interventions to improve social interaction among those students could be beneficial, decreasing the prevalence of CMD in this group.

Depressive symptoms and harmful alcohol use in hepatitis C patients: prevalence and correlates.

INTRODUCTION: It is important to understand the characteristics and vulnerabilities of people who have hepatitis C because this disease is currently an important public health problem. The objective of this study was to estimate the prevalence of depressive symptoms and harmful alcohol use in patients with hepatitis C and to study the association between these outcomes and demographic, psychosocial and clinical variables. METHODS: This cross-sectional, descriptive and analytical study involved 82 hepatitis C patients who were being treated with pegylated interferon and ribavirin at a public university hospital. The primary assessments used in the study were the Alcohol Use Disorders Identification Test and the Beck Depression Inventory. Bivariate analyses were followed by logistic regression. RESULTS: The prevalence of depressive symptoms was 30.5% (n=25), and that of harmful alcohol use was 34.2% (n=28). Logistic regression analysis showed that individuals who were dissatisfied with their social support (OR=4.41; CI=1.00-19.33) and were unemployed (OR=6.31; CI=1.44-27.70) were at a higher risk for depressive symptoms, whereas harmful alcohol use was associated with the male sex (OR=6.78; CI=1.38-33.19) and the use of illicit substances (OR=7.42; CI=1.12-49.00). CONCLUSIONS: High prevalence rates of depressive symptoms and harmful alcohol use were verified, indicating vulnerabilities that must be properly monitored and treated to reduce emotional suffering in this population.

Depressive symptoms and harmful alcohol use in hepatitis C patients: prevalence and correlates

Introduction It is important to understand the characteristics and vulnerabilities of people who have hepatitis C because this disease is currently an important public health problem. The objective of this study was to estimate the prevalence of depressive symptoms and harmful alcohol use in patients with hepatitis C and to study the association between these outcomes and demographic, psychosocial and clinical variables. Methods This cross-sectional, descriptive and analytical study involved 82 hepatitis C patients who were being treated with pegylated interferon and ribavirin at a public university hospital. The primary assessments used in the study were the Alcohol Use Disorders Identification Test and the Beck Depression Inventory. Bivariate analyses were followed by logistic regression. Results The prevalence of depressive symptoms was 30.5% (n=25), and that of harmful alcohol use was 34.2% (n=28). Logistic regression analysis showed that individuals who were dissatisfied with their social support (OR=4.41; CI=1.00-19.33) and were unemployed (OR=6.31; CI=1.44-27.70) were at a higher risk for depressive symptoms, whereas harmful alcohol use was associated with the male sex (OR=6.78; CI=1.38-33.19) and the use of illicit substances (OR=7.42; CI=1.12-49.00). Conclusions High prevalence rates of depressive symptoms and harmful alcohol use were verified, indicating vulnerabilities that must be properly monitored and treated to reduce emotional suffering in this population. .

Social support and common mental disorder among medical students / Apoio social e transtorno mental comum entre estudantes de Medicina

INTRODUCTION: Different kinds of psychological distress have been identified for students in the health field, especially in the medical school. OBJECTIVE: To estimate the prevalence of mental suffering among medical students in the Southeastern Brazil and asses its association with social support. METHODS: It is a cross-sectional study. Structured questionnaires were applied for students from the 1st up to the 6th years of the medical school of Universidade Estadual Paulista "Júlio de Mesquita Filho", assessing demographic variables related to aspects of graduation and adaptation to the city. Psychological suffering was defined as a common mental disorder (CMD) assessed by the Self Reporting Questionnaire (SRQ-20). Social support was assessed by the social support scale of the Medical Outcomes Study (MOS). The association between the outcome and explanatory variables was assessed by the χ2 test and Logistic Regression, for the multivariate analyses, using p < 0.05. RESULTS: The response rate was of 80.7%, with no differences between sample and the population regarding gender (p = 0.78). The average age was 22 years old (standard deviation - SD = 2.2), mainly women (58.2%) and students who were living with friends (62%). The prevalence of CMD was 44.9% (95%CI 40.2 - 49.6). After the multivariate analyses, the explanatory variables that were associated with CMD were: feeling rejected in the past year (p < 0.001), thinking about leaving medical school (p < 0.001) and "interaction" in the MOS scale (p = 0.002). CONCLUSIONS: The prevalence of CMD among medical students was high and insufficient social support was an important risk factor. Our findings suggest that interventions to improve social interaction among those students could be beneficial, decreasing the prevalence of CMD in this group. .

INTRODUÇÃO: Diferentes formas de sofrimento psíquico têm sido identificadas em estudantes da área da saúde, em especial no curso de Medicina. OBJETIVO: Estimar a prevalência de sofrimento psíquico entre estudantes de Medicina em uma faculdade no Sudeste do Brasil e avaliar sua associação com apoio social. MÉTODO: Trata-se de um estudo transversal. Foram aplicados questionários para alunos do 1º ao 6º ano do curso de Medicina da Universidade Estadual Paulista "Júlio de Mesquita Filho", investigando-se características demográficas relacionadas ao curso e à adaptação à cidade. Sofrimento psíquico foi investigado na forma de Transtorno Mental Comum (TMC), avaliado por meio do Self-Reporting Questionnaire (SRQ-20). Apoio social foi avaliado com a Escala de Apoio Social (EAS). As associações entre o desfecho e as variáveis explanatórias foram analisadas por meio do teste do χ2 e, na análise multivariada, por meio da Regressão Logística, com p < 0,05. RESULTADOS: A taxa de resposta foi de 80,7%, não havendo diferença estatística entre a mostra e a população-alvo no que diz respeito ao gênero (p = 0,78). A média de idade foi de 22 anos (desvio padrão - DP = 2,2) com predomínio de mulheres (58,2%) e estudantes que vivem com amigos (62%). A prevalência de TMC foi de 44,9% (IC95% 40,2 - 49,6). Após a análise multivariada, mantiveram-se associados a TMC: sentir-se rejeitado no último ano (p < 0,001), ter pensado ou pensar em abandonar o curso (p < 0,001) e "interação", avaliada pela EAS (p = 0,002). CONCLUSÕES: A prevalência de TMC entre estudantes de Medicina mostrou-se elevada, identificando-se o apoio social insuficiente como fator de risco. Esses achados sugerem que intervenções ...

[Reasons for medical follow-up dropout among patients with arterial hypertension: the patient's perspective]. / Motivos do abandono do seguimento médico no cuidado a portadores de hipertensão arterial: a perspectiva do sujeito.

Arterial hypertension is a relevant public health problem as it is a risk factor for cardiovascular diseases, the major cause of mortality in Brazil. Low compliance and treatment dropout are among the main obstacles to individual control strategies. This study aimed at assessing the reasons for failure in medical appointment follow-up among a cohort of patients under treatment for four years in a primary care service. Thus, semi-structured interviews were conducted with 50 individuals who had dropped out of medical appointments. Statements were assessed by using thematic content analysis. The reported reasons for dropping out were most frequently related with the healthcare service itself - its organization and structure, and doctor-patient relationship - or treatment at another healthcare service. The reasons related with the patients themselves, such as absence of symptoms, improvement and/or normalization of arterial hypertension, as well as alcohol consumption contributed to the discontinuation of the treatment. To study the reasons for treatment dropout through the patients' eyes showed the abundance and diversity of problems involved.

Motivos do abandono do seguimento médico no cuidado a portadores de hipertensão arterial: a perspectiva do sujeito / Reasons for medical follow-up dropout among patients with arterial hypertension: the patient's perspective

A hipertensão arterial é um expressivo problema de saúde pública enquanto fator de risco para as doenças cardiovasculares e principal grupo de causas de mortalidade no Brasil. A baixa adesão e o abandono do tratamento estão entre os principais obstáculos às estratégias individuais de controle. Estudam-se os motivos do abandono do seguimento médico em uma coorte de pacientes em tratamento de hipertensão arterial, em serviço de atenção primária à saúde, acompanhados por um período de quatro anos. Foram realizadas entrevistas semiestruturadas com cinquenta pessoas com hipertensão que abandonaram o seguimento médico. As respostas foram analisadas mediante a técnica de análise temática de conteúdo. Os motivos relatados para o abandono do seguimento mostraram predomínio de razões ligadas ao próprio serviço de saúde - sua organização, estrutura e a relação médico-paciente - e, ainda, tratamento em outro serviço de saúde. Razões de natureza psicossocial, como a ausência de sintomas, a melhora e/ou a normalização da pressão arterial e o consumo de álcool também contribuíram para o abandono do cuidado. Estudar os motivos do abandono na perspectiva do próprio sujeito permitiu verificar a riqueza e diversidade de problemas envolvidos no cuidado requerido.

Arterial hypertension is a relevant public health problem as it is a risk factor for cardiovascular diseases, the major cause of mortality in Brazil. Low compliance and treatment dropout are among the main obstacles to individual control strategies. This study aimed at assessing the reasons for failure in medical appointment follow-up among a cohort of patients under treatment for four years in a primary care service. Thus, semi-structured interviews were conducted with 50 individuals who had dropped out of medical appointments. Statements were assessed by using thematic content analysis. The reported reasons for dropping out were most frequently related with the healthcare service itself - its organization and structure, and doctor-patient relationship - or treatment at another healthcare service. The reasons related with the patients themselves, such as absence of symptoms, improvement and/or normalization of arterial hypertension, as well as alcohol consumption contributed to the discontinuation of the treatment. To study the reasons for treatment dropout through the patients' eyes showed the abundance and diversity of problems involved.

Crenças sobre sexualidade entre estudantes de Medicina: uma comparação entre gêneros / Beliefs about sexuality among medical students: a comparison between gender

OBJETIVO: Identificar informações sobre sexualidade entre estudantes de Medicina e analisar as diferenças quanto a gênero e ano do curso. MÉTODO: Foi aplicado um questionário estruturado a estudantes da Faculdade de Medicina de Botucatu, com questões sobre sexualidade e vida sexual dos sujeitos. A aplicação ocorreu em sala de aula, sendo que 455 estudantes (82,6 por cento) aceitaram participar do estudo. A análise foi estratificada para gênero e ano do curso, sendo utilizado o teste do qui-quadrado. RESULTADOS: Comparando-se primeiros e últimos anos, observou-se aumento da freqüência de vida sexual ativa, mas não de satisfação. Crenças predominaram sobre crendices, tendo sido observadas diferenças entre os gêneros. Aspectos da sexualidade feminina e da homossexualidade apresentaram um significativo percentual de respostas equivocadas. CONCLUSÕES: Entre estudantes de Medicina ainda persiste desinformação sobre aspectos específicos da sexualidade humana. A formação médica precisa abarcar a sexualidade em seus múltiplos aspectos, capacitando os profissionais a lidarem com a sexualidade de seus pacientes.

OBJECTIVE: Gather information about sex knowledge and sexuality among medical students for analyzing differences related to gender and study year. METHODS: A structured questionnaire was applied to students of the School of Medicine of Botucatu, composed by questions about sexuality and sexual activity. The questionnaire was applied in class and 455 students agreed to participate in the study. The analysis was stratified by gender and study year using chi-square test. RESULTS: A comparison of data obtained from first-year and final-year students revealed an increase in the frequency of active sex life, but not in satisfaction. Beliefs predominate over misbeliefs, with differences among gender. Female sexuality and homosexuality-related aspects however have revealed a significant percentage of erroneous answers. CONCLUSIONS: There still exists disinformation about specific issues of human sexuality among medical students. Medical education thus needs to address sexuality in its multiple aspects for enabling the students to deal with the sexuality of their patients.

[Prevalence and risk factors of common mental disorders among medical students]. / Prevalência e fatores de risco para transtornos mentais comuns entre estudantes de medicina.

OBJECTIVE: To estimate the prevalence and assess risk factors of common mental disorders among medical students. METHODS: A cross-sectional study was carried out comprising 551 university medical students in the state of São Paulo, Southeastern Brazil. A self-administered questionnaire to collect sociodemographic and course-related data as well as the Self-Reporting Questionnaire were used. Both Chi-square test and logistic regression were used in data analyses. RESULTS: A total of 82.6% of the students enrolled in the course participated in the study. Most of them were women (61%), 60% aged between 20 and 23 years, and 99% were from other cities. The prevalence of common mental disorders was 44.7% and they were independently associated with: difficulty in making friends (OR=2.0), poor self-evaluation of academic performance (OR=1.7), thoughts of dropping out of the medical course (OR=5.0) and perceived lack of emotional support (OR=4.6). Although prevalence of these disorders was associated with the course period in the first analysis, this association was not maintained in the multivariate analysis. CONCLUSIONS: The prevalence of common mental disorders was shown to be high among medical students, associated with variables concerning support networks. Emotionally tense experiences such as dealing with seriously ill patients and peer group formation in the last years of the medical course are potentially strong stressors, especially for those with poor social support. It is suggested that educational institutions should be aware of that and make interventions aiming at treating and caring for the students' distress.

Prevalência e fatores de risco para transtornos mentais comuns entre estudantes de medicina / Prevalence and risk factors of common mental disorders among medical students

OBJETIVO: Estimar a prevalência de transtornos mentais comuns entre estudantes de medicina e respectivos fatores de risco. MÉTODOS: Estudo transversal realizado com 551 universitários de um curso de medicina de Botucatu, SP. Utilizou-se questionário auto-aplicável investigando aspectos sócio demográficos, relacionados ao curso e o Self Reporting Questionnaire. Para análise dos dados empregaram-se os testes de qui-quadrado e regressão logística. RESULTADOS: Participaram 82,6 por cento dos alunos matriculados no curso, predominando mulheres (61 por cento), jovens (60 por cento 20-23 anos), procedentes de outros municípios (99 por cento). A prevalência de transtornos mentais comuns foi de 44,7 por cento associando-se independentemente a: dificuldade para fazer amigos (RC=2,0), avaliação ruim sobre desempenho escolar (RC=1,7), pensar em abandonar o curso (RC=5,0), não receber o apoio emocional de que necessita (RC=4,6). Embora na primeira análise a prevalência tenha se mostrado associada ao ano do curso, esta associação não se manteve na análise multivariada. CONCLUSÕES: A prevalência de transtornos mentais comuns mostrou-se elevada entre os estudantes de medicina, associando-se a variáveis relacionadas à rede de apoio. As experiências emocionalmente tensas como o contato com pacientes graves, formação de grupos, entre outras, vividas nos últimos anos do curso, são provavelmente potentes estressores, especialmente para sujeitos com uma rede de apoio considerada deficiente. Sugere-se que instituições formadoras estejam atentas a esse fato, estabelecendo intervenções voltadas ao acolhimento e ao cuidado com o sofrimento dos estudantes.

OBJECTIVE: To estimate the prevalence and assess risk factors of common mental disorders among medical students. METHODS: A cross-sectional study was carried out comprising 551 university medical students in the state of São Paulo, Southeastern Brazil. A self-administered questionnaire to collect sociodemographic and course-related data as well as the Self-Reporting Questionnaire were used. Both Chi-square test and logistic regression were used in data analyses. RESULTS: A total of 82.6 percent of the students enrolled in the course participated in the study. Most of them were women (61 percent), 60 percent aged between 20 and 23 years, and 99 percent were from other cities. The prevalence of common mental disorders was 44.7 percent and they were independently associated with: difficulty in making friends (OR=2.0), poor self-evaluation of academic performance (OR=1.7), thoughts of dropping out of the medical course (OR=5.0) and perceived lack of emotional support (OR=4.6). Although prevalence of these disorders was associated with the course period in the first analysis, this association was not maintained in the multivariate analysis. CONCLUSIONS: The prevalence of common mental disorders was shown to be high among medical students, associated with variables concerning support networks. Emotionally tense experiences such as dealing with seriously ill patients and peer group formation in the last years of the medical course are potentially strong stressors, especially for those with poor social support. It is suggested that educational institutions should be aware of that and make interventions aiming at treating and caring for the students' distress.

[Contraceptive measures and HIV transmission protection among women with HIV/AIDS]. / Medidas contraceptivas e de proteção da transmissão do HIV por mulheres com HIV/Aids.

OBJECTIVE: Sexual intercourse is currently the route of transmission among women that has most contributed to the feminization of the HIV/AIDS epidemic. As an ongoing effort to establish more appropriate standards for health counseling, the study's purpose was to investigate the use of contraceptive methods that would also prevent HIV/AIDS women against disease transmission. METHODS: An exploratory study was developed in an outpatient clinic of a public university hospital, a reference center of HIV/AIDS patients in the mid-south region of the state of São Paulo, Brazil, during a 5-month-period (2000 and 2001). The study was carried out in 73 HIV/AIDS women. Data were collected using a semi-structured questionnaire exploring subjects' sociodemographics, contraception method used and HIV status of their sex partners. A descriptive data analysis was performed and the contents of open answers were grouped into themes. Fischer's exact test was applied for analyzing some variables at a 5% significance level. Content analysis was carried out according to Bardin's proposal.(2) RESULTS: Most women at reproductive age were married and had been infected almost exclusively through heterosexual contact. Of them, 35.4% reported having an HIV discordant partner and 13.7% used inadequate contraceptive methods that failed to protect them against HIV transmission. CONCLUSIONS: The study results call for the need of continuous education on safer sex among HIV/AIDS women to empower them to discuss with their partners alternative options of exercising their sexuality and to raise awareness on their contraceptive choices in a way to protect their own health, their partner's and even their unborn offspring's health.