Health-related quality of life of medical students.

OBJECTIVES: Mental problems such as stress, anxiety and depression have been described among medical students and are associated with poor academic and professional performance. It has been speculated that these problems impair students' quality of life (QoL). The authors aimed to assess the health-related QoL (HRQL) of medical students throughout their 6 years of training at a school with a traditional curriculum. METHODS: Of a total of 490 students attending our institution's medical school, 38 were surveyed in February 2006 (incoming Year 1 group, surveyed when students were in the second week of Year 1 classes) and 352 were surveyed in February 2007 (students in Years 1-6). Students self-reported their HRQL and depressive symptoms using the Short-Form Health Survey (SF-36) and the Beck Depression Inventory (BDI). Comparisons were performed according to year in training, presence of depressive symptoms, gender, living arrangements and correlations with family income. RESULTS: The students' ages ranged from 18 to 31 years (median 22.3 years). Students in Years 2, 3, 4 and 6 had lower scores for mental and physical dimensions of HRQL compared with the incoming Year 1 group (P < 0.01), with the largest difference observed for Year 3 students. Students with depressive symptoms had lower scores in all domains of the SF-36 (P < 0.01). Female students had lower HRQL scores than males (P < 0.01). No differences were observed for students living with versus without family and no correlation with family income was found. CONCLUSIONS: Major impairments in HRQL were observed among Year 3 students, students with depressive symptoms and women. Medical schools should institute efforts to ensure that students' HRQL and emotional support are maintained, particularly during critical phases of medical training.

Psychometric properties of the Child Health Assessment Questionnaire (CHAQ) applied to children and adolescents with cerebral palsy.

BACKGROUND: Cerebral palsy (CP) patients have motor limitations that can affect functionality and abilities for activities of daily living (ADL). Health related quality of life and health status instruments validated to be applied to these patients do not directly approach the concepts of functionality or ADL. The Child Health Assessment Questionnaire (CHAQ) seems to be a good instrument to approach this dimension, but it was never used for CP patients. The purpose of the study was to verify the psychometric properties of CHAQ applied to children and adolescents with CP. METHODS: Parents or guardians of children and adolescents with CP, aged 5 to 18 years, answered the CHAQ. A healthy group of 314 children and adolescents was recruited during the validation of the CHAQ Brazilian-version. Data quality, reliability and validity were studied. The motor function was evaluated by the Gross Motor Function Measure (GMFM). RESULTS: Ninety-six parents/guardians answered the questionnaire. The age of the patients ranged from 5 to 17.9 years (average: 9.3). The rate of missing data was low (<9.3%). The floor effect was observed in two domains, being higher only in the visual analogue scales (< or = 35.5%). The ceiling effect was significant in all domains and particularly high in patients with quadriplegia (81.8 to 90.9%) and extrapyramidal (45.4 to 91.0%). The Cronbach alpha coefficient ranged from 0.85 to 0.95. The validity was appropriate: for the discriminant validity the correlation of the disability index with the visual analogue scales was not significant; for the convergent validity CHAQ disability index had a strong correlation with the GMFM (0.77); for the divergent validity there was no correlation between GMFM and the pain and overall evaluation scales; for the criterion validity GMFM as well as CHAQ detected differences in the scores among the clinical type of CP (p < 0.01); for the construct validity, the patients' disability index score (mean:2.16; SD:0.72) was higher than the healthy group (mean:0.12; SD:0.23)(p < 0.01). CONCLUSION: CHAQ reliability and validity were adequate to this population. However, further studies are necessary to verify the influence of the ceiling effect on the responsiveness of the instrument.

Mortalidade materna em cidade de médio porte, Brasil, 1997 / Maternal mortality in a midsize city, Brazil, 1997

Objetivo: A real magnitude do problema das mortes maternas em Uberlândia, MG, Brasil, é pouco conhecida, sendo que o objetivo do estudo é conhecer o perfil da mortalidade materna desse município. Método: Utilizaram-se, como fonte de dados, as declaraçöes de óbito de mulheres falecidas entre 10 e 49 anos de idade, residentes no município de Uberlândia, MG. Entrevistaram-se as famílias dessas mulheres para identificar o estado gestacional no momento do óbito. As mortes caracterizadas como materna foram investigadas nos serviços de saúde, em prontuários e em entrevistas médicas. Foram analisados os óbitos maternos ocorridos até um ano após o término da gestaçäo, considerando-se: pré-natal, período gestacional, tipo de parto, complicaçöes em gestaçöes anteriores, causa básica da morte, local de ocorrência e possibilidade de se evitar o óbito. Calcularam-se os coeficientes de mortalidade materna (CMM) por 100.000 nascidos vivos. Resultados: Do total de 204 óbitos, analisaram-se 173 de residentes no município. Ocorreram 6 mortes maternas, sendo 4 (66,7 por cento) até 42 dias após o parto e 2 (33,3 por cento) de 43 dias a 1 ano; 5(83,3 por cento) foram devidas a causas obstétricas diretas (toxemia - 60 por cento e hemorragia - 40 por cento) e 1 (16,7 por cento), indireta (cardiopatia). O CMM a partir das mortes maternas declaradas foi de 22,2 e o corrigido elevou-se para 66,6. Conclusöes: O CMM encontrado está acima do aceitável. Faz-se necessária uma análise acurada da qualidade do pré-natal e do parto, bem como do registro das declaraçöes de óbito