The results indicate that the concept of quality of life is subjective, tied to personal values and influenced by the repercussions of the health-disease process. In addition, they can guide actions based on interdisciplinary assistance aimed at the real needs of these patients.

Objectives:to compare the quality of life and religious-spiritual coping of palliative cancer care patients with a group of healthy participants; assess whether the perceived quality of life is associated with the religious-spiritual coping strategies; identify the clinical and sociodemographic variables related to quality of life and religious-spiritual coping. Method:cross-sectional study involving 96 palliative outpatient care patient at a public hospital in the interior of the state of São Paulo and 96 healthy volunteers, using a sociodemographic questionnaire, the McGill Quality of Life Questionnaire and the Brief Religious-Spiritual Coping scale. Results:192 participants were interviewed who presented good quality of life and high use of Religious-Spiritual Coping. Greater use of negative Religious-Spiritual Coping was found in Group A, as well as lesser physical and psychological wellbeing and quality of life. An association was observed between quality of life scores and Religious-Spiritual Coping (p<0.01) in both groups. Male sex, Catholic religion and the Brief Religious-Spiritual Coping score independently influenced the quality of life scores (p<0.01). Conclusion:both groups presented high quality of life and Religious-Spiritual Coping scores. Male participants who were active Catholics with higher Religious-Spiritual Coping scores presented a better perceived quality of life, suggesting that this coping strategy can be stimulated in palliative care patients.

This study's aim was to identify the main difficulties faced by caregivers of patients receiving comfort care at home and how they perceive the support provided by the Family Health Strategy. Qualitative research involving 50 caregivers providing comfort care to patients cared for by the Family Health Strategy in a city in the State of São Paulo, Brazil. The interviews were transcribed and analyzed using the Collective Subject Discourse methodological strategy. The results show that countless difficulties are experienced, which are linked to a lack of support, of equipment and financial resources and a lack of preparation to deal with death in the context of terminal illness. The program actions are limited and sporadic. The difficulties caregivers experience reflect unpreparedness combined with social and economic instability experienced in the home context. Additionally, caregivers are confronted with restricted and discontinued care provided by the program. DESCRIPTORS:Family health program. Palliative care. Primary health care. Caregivers. DIFICULDADES DE CUIDADORES DE PACIENTES EM CUIDADOSPALIATIVOS NA ESTRATÉGIA DA SAÚDE DA FAMÍLIA RESUMO: Objetivou-se desvelar as principais dificuldades enfrentadas pelos cuidadores de pacientes em cuidados paliativos no domicílio e compreender a percepção dos mesmos em relação ao suporte oferecido pela Estratégia da Saúde da Família. Pesquisa qualitativa realizado com 50 cuidadores de pacientes em cuidados paliativos, atendidos pela Estratégia da Saúde da Família em município do interior de São Paulo. As entrevistas foram transcritas e analisadas utilizando-se a estratégia metodológica do Discurso do Sujeito Coletivo. As dificuldades vivenciadas pelos cuidadores são inúmeras e atreladas à falta de rede de apoio, de recursos humanos, materiais, financeiros e ao despreparo para lidar com a morte no contexto da terminalidade. As ações desenvolvidas pela Estratégia da Saúde da Família são limitadas e pontuais. As dificuldades sentidas pelos cuidadores refletem o despreparo pessoal aliado à precariedade social e econômica vivenciadas no contexto domiciliar. Além disso, defrontam-se com a atenção restrita e descontinuada prestada pelo programa. DESCRITORES:Programa saúde da família. Cuidados paliativos. Atenção primária à saúde. Cuidadores. DIFICULTADES DE CUIDADORES DE PACIENTES EN CUIDADOS PALIATIVOS EN LA ESTRATEGIA DE SALUD DE LA FAMILIARESUMEN: Se intentó desvelar las principales dificultades enfrentadas por los cuidadores de pacientes en cuidados paliativos en domicilio y comprender su percepción del soporte ofrecido por la Estrategia de Salud de la Familia. Investigación cualitativa con 50 cuidadores de pacientes en cuidados paliativos, atendidos por la Estrategia de Salud de la Familia en un municipio del interior de São Paulo. Las entrevistas fueron transcritas y analizadas mediante la estrategia del Discurso del Sujeto Colectivo. Las dificultades vividas son innúmeras y vinculadas a la falta de red de apoyo, de recursos humanos, materiales, financieros y de ...

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Fatores de risco para lesão renal aguda em pacientes clínicos intensivosRisk factors for acute renal injury in intensive clinical patients Factores de riesgo para lesión renal aguda en pacientes clínicos intensivos Cariston Rodrigo Benichel https://orcid.org/0000-0003-2781-0292 1 Silmara Meneguin https://orcid.org/0000-0003-3853-5134 1 ¹Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brasil.Confl itos de interesse: nada a declarar. ResumoObjetivo: Identifi car prevalência e fatores associados à lesão renal aguda em pacientes clínicos intensivos, e compará-los com um grupo controle; analisar se a coexistência de fatores constitui preditor de risco para o desenvolvimento de lesão renal aguda.Métodos: Estudo caso-controle, com abordagem quantitativa, realizado em unidade de terapia intensiva geral adulto do interior de São Paulo, Brasil, com 205 pacientes que desenvolveram lesão renal aguda e o mesmo número de controles, durante os anos de 201 4 e 2015. Coleta de dados realizada mediante levantamento dos registros de prontuário. Relações foram estatisticamente signifi cativas se p<0,05.Resultados: A prevalência de lesão renal aguda foi de 7,5% e os principais fatores associados foram: hipertensão arterial (p=0,004; OR=1,9615; IC=1,0491-3,6645); hipovolemia (p=0,006; OR=5,6071; IC=1,6382-19,1854); insufi ciência cardíaca (p=0,003; OR=5,3123; IC=1,7521-16,1051); noradrenalina (p<0,0001; OR=9,4913; IC=4,4824-20,0981); dopamina (p=0,0009; OR=3,5212; IC=1,6701-7,4242); dobutamina (p=0,0131; OR=5,2612; IC=1,4172-19,5323); e antibióticos simultâneos (p<0,0001; OR=3,7881; IC=2,0253-7,0884). A coexistência de mais de três fatores de risco foi estatisticamente signifi cante para lesão renal aguda (p<0,0001; OR=5,0074; IC=2,5601-9,7936).Conclusão: A lesão renal aguda é um evento multifatorial que se associou à doença de base, às complicações decorrentes da gravidade dos participantes e à utilização de medicamentos nefrotóxicos. Ter três ou mais fatores de risco aumentou as chances para o desenvolvimento da doença. AbstractObjective: Identify the prevalence and associated factors of acute renal injury in intensive clinical patients and compare them with a control group; analyze if the coexistence of factors serves as a predictor for the risk of developing acute renal injury.Method: Case-control study with a quantitative approach, developed at a general adult intensive care unity in the interior of São Paulo, Brazil, involving 205 patients who developed acute renal injury and the same number of controls, during 2014 and 2015. Data were collected through a survey of patient fi le records. Relationships were statistically signifi cant if p<0.05.Results: The prevalence of acute renal injury was 7.5% and the main associated factors were: arterial hypertension (p=0.004;Fatores de risco para lesão renal aguda em pacientes clínicos intensivos 7.0884). The coexistence of more than three risk factors was statistically significant for acute renal injury (p<0.0001; OR=5.0074; CI=2....

BackgroundAlthough asymptomatic, melasma inflicts significant impact on quality of life. MELASQoL is the main instrument used to assess quality of life associated with melasma, it has been validated in several languages, but its latent dimensional structure and psychometric properties haven´t been fully explored.ObjectivesTo evaluate psychometric characteristics, information and dimensional structure of the Brazilian version of MELASQoL.MethodsSurvey with patients with facial melasma through socio-demographic questionnaire, DLQI-BRA, MASI and MELASQoL-BP, exploratory and confirmatory factor analysis, internal consistency of MELASQoL and latent dimensions (Cronbach's alpha). The informativeness of the model and items were investigated by the Rasch model (ordinal data).ResultsWe evaluated 154 patients, 134 (87%) were female, mean age (± SD) of 39 (± 8) years, the onset of melasma at 27 (± 8) years, median (p25-p75) of MASI scores , DLQI and MELASQoL 8 (5-15) 2 (1-6) and 30 (17-44). The correlation (rho) of MELASQoL with DLQI and MASI were: 0.70 and 0.36. Exploratory factor analysis identified two latent dimensions: Q1-Q3 and Q4-Q10, which had significantly more adjusted factor structure than the one-dimensional model: Χ2 / gl = 2.03, CFI = 0.95, AGFI = 0.94, RMSEA = 0.08. Cronbach's coefficient for the one-dimensional model and the factors were: 0.95, 0.92 and 0.93. Rasch analysis demonstrated that the use of seven alternatives per item resulted in no increase in the model informativeness.ConclusionsMELASQoL-BP showed good psychometric performance and a latent structure of two dimensions. We also identified an oversizing of item alternatives to characterize the aggregate information to each dimension.

The perception of life quality impairment in melasma is influenced by low scholarly, low family income, single marital status and greater clinical severity.

BACKGROUNDMelasma has a major impact on quality of life. MELASQoL is the only validated specific psychometric instrument to evaluate melasma QoL.OBJECTIVETo develop and validate a multidimensional questionnaire for evaluating quality of life related to facial melasma.METHODSCross-sectional study performed in 2 institutions (public and private) from Brazil. Two focus groups were carried out: 5 board-certified dermatologists and 10 melasma patients, indicating the dimensions and significant units of melasma QoL. The preliminary questionnaire with 49 itens was applied to 154 facial melasma patients. Item reduction was performed by Rasch analysis. Parallel evaluations of clinical (MASI), demographic, and QoL aspects (MELASQoL, DLQI) were performed. The dimensional structure was assessed by confirmatory factor analysis. Temporal stability was tested in a subgroup of 42 individuals within 7-14 days.RESULTSThe mean (SD) age of the 154 interviewed subjects was 39±8 years, and 87% were females. The median (p25-p75) DLQI and MELASQoL were: 2 (1-6) and 30 (17-44). HRQ-Melasma consisted of 19 items distributed in 4 dimensions: Physical/Appearance, Social/Professional, Psychological, and Treatment. Cronbach’s alpha for HRQ-Melasma was 0.96, and >0.74 for each dimension. There was high correlation between HRQ-Melasma and DLQI and MELASQoL (rho=0.80 and 0.83), but modest with MASI (rho=0.35). Dimensional structure of HRQ-Melasma was stated by confirmatory factor analysis coefficients. Test-retest analysis disclosed an intraclass correlation coefficient of 0.91 (p<0.01).STUDY LIMITATIONSSingle-center study.CONCLUSIONSA specific instrument to evaluate QoL in melasma with multidimensional characteristics was developed and validated, with appropriate psychometric performance.