This is a descriptive, cross-sectional study aimed at investigating the health-related quality of life (HRQoL) of nursing students and its relationship with year of training, sociodemographic variables and the intensity of depressive symptoms. A convenience sample of 256 students, out of 353 eligible (72%), responded to the Medical Outcomes Study -The 36 Item ShortForm Health Survey (SF-36) and the Beck Depression Inventory (BDI) (self-administered).Final-year students, females and students with a higher intensity of depressive symptoms presented lower SF-36 scores in the physical functioning, vitality and social functioning domains. Institutional psychopedagogic support programs may minimize this negative impact on the HRQoL and encourage better professional performance of students in higher vulnerability situations. Calidad de vida relacionada a la salud y síntomas depresivos de estudiantes del curso de graduación en enfermería.Se trata de un estudio descriptivo y transversal que investigó la calidad de vida relacionada a la salud (CVRS) de los estudiantes de enfermería y la relación con años de estudio, las variables sociodemográficas y la intensidad de los síntomas depresivos. Una muestra accidental de 256 estudiantes de 353 elegibles (72%) respondió el Medical Outcomes Study -The 36 Item Short-Form Health Survey (SF-36) y el Inventario de Depresión de Beck (IDB) (auto-aplicación). Estudiantes del último año del curso, los del sexo femenino y con mayor intensidad de síntomas depresivos, presentaron menores puntuaciones del SF-36 en los dominios capacidad funcional, vitalidad y aspectos sociales. El impacto es mayor en el último año del curso, los estudiantes de sexo femenino o con síntomas depresivos. Programas de apoyo psicológico podrían minimizar este impacto y contribuir a una mejor formación y desempeño profesional de los estudiantes en situación de mayor vulnerabilidad.

Al lergic rhinitis (AR) remains a significant pediatric health problem because of the burden of uncontrolled symptoms on daily activities and on general well being. Aim: to assess the impact of AR on health-related quality of life (HRQL) of children and adolescents using a generic instrument, the Child Health Questionnaire (CHQ -PF50). Methods: Between January and November 2004, parents or caregivers of 23 children and adolescents with AR without comorbidities and with positive prick tests for at least one air allergen were invited to participate of a cross-sectional study and asked to answer the self-administered CHQ-PF50. The scores were compared to those of healthy children and adolescents. Results: Patient scores were lower (p<0.05) than healthy subsets in both the physical and psychosocial summaries and in most of the CHQ-PF50 scales (p<0,05), except for the "change in health" scale. The size effect was higher in the physical score compared to the psychosocial summary score. Conclusions: allergic rhinitis has a global negative impact on the HRQL of children and adolescents, with major repercussions in physical function; AR also negatively affects family relations.

Rheumatic fever is still the most commonly seen rheumatic disease in Brazilian pediatric rheumatology clinics. It remains a significant health problem since subsequent cardiac sequelae represent one of the most important causes of chronic heart disease in children. We reviewed the clinical manifestations of rheumatic fever in 786 patients followed at seven pediatric rheumatology clinics in the state of São Paulo, Brazil. All patients were diagnosed according to revised Jones' criteria. Regarding major criteria, 396 (50.4%) children exhibited carditis, 453 (57.6%) polyarthritis, 274 (34.8%) chorea, 13 (1.6%) erythema marginatum, and 12 (1.5%) subcutaneous nodules. Valvular lesions documented by echocardiography in the absence of accompanying auscultatory findings were found in 144 (18.3%) patients. Migratory polyarthritis was observed in 290 (64.0%) patients with articular involvement. Documented previous streptococcal infection assessed by serum antistreptolysin (ASO) titers occurred in 531 (67.5%) patients. Even though prophylaxis with benzathine penicillin was recommended to all patients, recurrent attacks were observed in 147 (18.7%). We emphasize the high frequency of chorea, silent carditis and recurrences in our series as well as the variable clinical presentation of arthritis in rheumatic fever. Multicenter studies should be encouraged to improve our understanding of the clinical features of rheumatic diseases in children and adolescents.

A esclerose múltipla (EM) é doença crônica, de caráter inflamatório e degenerativo 1 , que acomete preferencialmente adultos jovens 1,2 . A saúde e o bem estar desses indivíduos podem sofrer forte impacto pela doença e/ou efeitos colaterais de medicamentos, com interferência significativa na qualidade de vida (QV) de seus portadores. O conceito de QV refere-se a indicadores objetivos e subjetivos de felicidade e de satisfação 3 . Segundo a Organização Mundial de Saúde, a QV é definida como "a percepção do indivíduo de sua posição na vida, no contexto cultural e no sistema de valores em que ele vive e em relação a seus objetivos, expectativas, preocupações e desejos" 4 . Na área biomédica, a QV relacionada à saúde (QVRS) refere-se à satisfação e bem-estar do indiví-duo nos domínios físico, psicológico, social, econômi-co e espiritual em relação ao estado de saúde, uma combinação do estado de saúde com a resposta afetiva a esta condição 5 . PAlAVRAS-ChAVE: esclerose múltipla, qualidade de vida, avaliação em saúde. Health-related quality of life in multiple sclerosisABSTRACT -Multiple sclerosis (MS) is a chronic disease which may exert significant effects on the life of patients. Traditional outcome measures in MS lack in consider the effects of the disease on health-related quality of life (hRQol). The goal of this study is to measure hRQol in MS patients in the city of Uberlân-dia, State of Minas Gerais, Brazil. The Brazilian version of the SF-36 was applied in 23 MS patients and in 69 subjects of general population (blood donors) in Uberlândia. MS patients scored lower in all SF-36 scales than do the general population, principally in physical function domains. Patients with EDSS scores ≤3.5 had higher mean scores in four domains than do the patients with EDSS scores ≥4.0, and lower in all domains than control group. Depressive symptoms and heat intolerance showed correlation with SF-36 domains and components. In conclusion, MS patients have a significant negative impact on all hRQol domains measured by SF-36, compared with general population, even in the stages with lower disability.KEy wORDS: multiple sclerosis, quality of life, health evaluation.

OBJECTIVE: To evaluate the effect the type of hip fracture (femoral neck or trochanteric) has on the Health-Related Quality of Life of elderly subjects. METHODS: Forty-five patients with hip fractures (mean 74.30 ± 7.12 years), 24 with a femoral neck fracture and 21 with a trochanteric fracture, completed the 36-item Short Form Health Survey (SF-36) at baseline and four months after fracture. The Health-Related Quality of Life scores were compared according to fracture type, undisplaced and displaced femoral neck fractures, and stable and unstable trochanteric fractures. RESULTS: Compared to baseline, all patients scored lower in the physical functioning, role limitation-physical, bodily pain and vitality categories four months after the fracture had occurred. The SF-36 scores for all the scales did not differ significantly between patients with femoral neck versus trochanteric fractures, or between patients with displaced versus undisplaced femoral neck fractures and stable versus unstable trochanteric fractures. CONCLUSIONS: The mental and physical quality of life of elderly patients with a hip fracture is severely impaired one month after fracture, with partial recovery by the end of the fourth month. The negative impact on the Health-Related Quality of Life did not differ significantly according to fracture type

The presence of truth and honesty is a permanent demand, and becomes vital the more committed and intimate a relationship is. Medical practice is relevant to this discussion when one questions whether or not a physician should always tell their patient the truth in the face of a progressive or potentially fatal disease, regarding their diagnosis, outcome, therapy and evolution of the specific disease. From this discussion we aim, with the present report, to look at the truth applicable to the patient-physician relationship, and its ethical and moral implications; and also to look at where the Brazilian Code of Medical Ethics (BCME) and the medical literature stand regarding this issue. One concludes that there are only two moments not to tell a patient the truth: when the patient does not want to be informed, and when the truth could be iatrogenic. The question now is, when would the truth be iatrogenic? Physicians, in our opinion, would not be able to judge solitarily when the truth might be deleterious to their patient. Alternatively, we proposed the appointment of a multidisciplinary commission to help the doctor with such a decision.

Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições, desde que o trabalho original seja corretamente citado. Adaptação transcultural e validação da escala de Saúde Global do PROMIS para a língua portuguesaCross-cultural adaptation and validation of the PROMIS Global Health scale in the Portuguese language Adaptación transcultural y validación de la escala de Salud Global del PROMIS a la lengua portuguesa

Brazilian educational guidelines reinforce patient-centered care communication skills as an important competence for medical students. The Four Habits Coding Scheme (4HCS) is an instrument used for teaching and assessing clinicians’ communication skills in a person-centered care approach. We aimed to translate and culturally adapt the 4HCS into Brazilian Portuguese. The translation process was accomplished in seven stages: initial translation, reconciliation, back translation, review by the author, independent review, consensus version through Delphi technique, review by a language coordinator, and pretest. During pretest, three independent observers assessed four medical consultations, which were performed by medical students and residents, that had been recorded in a real healthcare scenario. Reviewers had difficulty in reaching consensus on expressions referring to understanding the person as a whole, such as “Engage in small talk”, “Expansion of concerns”, “Elicit full agenda”, “Use patient’s frame of reference”, and “Explore plan acceptability”. They also had difficulty in reaching consensus on the translation of the word “clinician”, which was first translated as “physician”. Historical and cultural issues in the physician-patient relationship may have influenced this result. The Brazilian 4HCS is a culturally, conceptually, semantically and operationally sound instrument. It may represent an important advance for strengthening the person-centered care model in Brazil.