Sao Paulo Medical Journal最新文献

{"title":"Cognitive and social adaptation in autism spectrum disorder: A prospective cohort study.","authors":"Márcia Regina Fumagalli Marteleto, Jacy Perissinoto","doi":"10.1590/1516-3180.2023.0184.R1.16022024","DOIUrl":"10.1590/1516-3180.2023.0184.R1.16022024","url":null,"abstract":"<p><strong>Background: </strong>During development, children face a number of demands and cognitive, behavioral, and social challenges necessary for growth. Cognitive skills make individuals competent and allow them to interact with their environment.</p><p><strong>Objective: </strong>To identify the cognitive skills that promote better social insertion in children with autism spectrum disorder within 12 months.</p><p><strong>Design and setting: </strong>Prospective cohort study.</p><p><strong>Methods: </strong>In this study, 21 children aged 3-12 years were assessed, and their mothers were interviewed. Children were enrolled in regular or special autistic schools. Twelve months after the first assessment, the same children participated in the second assessment. In individual interviews, mothers provided data by answering the Vineland Adaptive Behavior Scale. Each child was assessed individually using the fourth edition of the Stanford Binet Intelligence Scale 4th Edition.</p><p><strong>Results: </strong>In the first assessment, the Stanford Binet areas and total scores correlated with the communication domains, daily life abilities, socialization, and total score of the Vineland Scale. After 12 months, a correlation was observed between the Stanford Binet areas and the total and communication domains, daily life abilities, socialization, motor abilities, and total score on the Vineland Scale.</p><p><strong>Conclusion: </strong>Logic mathematics and memory promote better social insertion in children with autism spectrum disorder. General cognitive ability promotes communication.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 5","pages":"e2023184"},"PeriodicalIF":1.3,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11034700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organ donation consent after death.","authors":"Valter Duro Garcia, José Osmar Medina de Abreu Pestana, Paulo Manuel Pêgo-Fernandes","doi":"10.1590/1516-3180.2024.1422.120324","DOIUrl":"10.1590/1516-3180.2024.1422.120324","url":null,"abstract":"","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 2","pages":"e20241422"},"PeriodicalIF":1.3,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Portuguese Advance Directives-a twist against futility? A cross sectional study.","authors":"Catarina Sampaio Martins, Rui Nunes","doi":"10.1590/1516-3180.2022.0537.R2.201023","DOIUrl":"10.1590/1516-3180.2022.0537.R2.201023","url":null,"abstract":"<p><strong>Background: </strong>Advance Directive documents allow citizens to choose the treatments they want for end-of-life care without considering therapeutic futility.</p><p><strong>Objectives: </strong>To analyze patients' and caregivers' answers to Advance Directives and understand their expectations regarding their decisions.</p><p><strong>Design and setting: </strong>This study analyzed participants' answers to a previously published trial, conceived to test the document's efficacy as a communication tool.</p><p><strong>Methods: </strong>Sixty palliative patients and 60 caregivers (n = 120) registered their preferences in the Advance Directive document and expressed their expectations regarding whether to receive the chosen treatments.</p><p><strong>Results: </strong>In the patient and caregiver groups, 30% and 23.3% wanted to receive cardiorespiratory resuscitation; 23.3% and 25% wanted to receive artificial organ support; and 40% and 35% chose to receive artificial feeding and hydration, respectively. The participants ignored the concept of therapeutic futility and expected to receive invasive treatments. The concept of therapeutic futility should be addressed and discussed with both the patients and caregivers. Legal Advanced Directive documents should be made clear to reduce misinterpretations and potential legal conflicts.</p><p><strong>Conclusion: </strong>The authors suggest that all citizens should be clarified regarding the futility concept before filling out the Advance Directives and propose a grammatical change in the document, replacing the phrase \"Health Care to Receive / Not to Receive\" with the sentence \"Health Care to Accept / Refuse\" so that patients cannot demand treatments, but instead accept or refuse the proposed therapeutic plans.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov ID NCT05090072.</p><p><strong>Url: </strong>https://clinicaltrials.gov/ct2/show/NCT05090072.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 3","pages":"e2022537"},"PeriodicalIF":1.3,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10962926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translation and cultural adaptation of the Positive Aspects of Caregiving Scale for caregivers of people living with dementia in Brazilian context: a methodological study.","authors":"Sofia Cristina Iost Pavarini, Aline Cristina Martins Gratão, Camila Rafael Ferreira Campos, Diana Quirino Monteiro, Elizabeth Joan Barham, Fabiana de Souza Orlandi, Gabriela Martins, Gustavo Carrijo Barbosa, Keila Cristianne Trindade da Cruz, Larissa Corrêa, Luana Aparecida da Rocha, Ludmyla Caroline de Souza Alves, Ana Carolina Ottaviani","doi":"10.1590/1516-3180.2023.0325.R1.23012024","DOIUrl":"10.1590/1516-3180.2023.0325.R1.23012024","url":null,"abstract":"<p><strong>Background: </strong>The Positive Aspects of Caregiving (PAC) scale is used to assess psychosocial benefits provided to caregivers by the task of caring. The PAC scale consists of nine items, assessed using a five-point Likert scale, with higher values indicating greater positive perceptions and gains from the caregiving experience.</p><p><strong>Objective: </strong>To translate and culturally adapt the PAC scale for informal Brazilian caregivers of people with dementia.</p><p><strong>Design and setting: </strong>A methodological study was conducted at the Federal University of São Carlos.</p><p><strong>Methods: </strong>The following stages were carried out: Translation; Synthesis of the translations; Back-translation; Evaluation by an experts' committee; and Pre-test.</p><p><strong>Results: </strong>Two independent professionals translated the PAC scale. The consensus version was obtained by merging both translations, which were back-translated into English by a third translator. The expert committee comprised three specialists in the area and project researchers. All scale items presented a Content Validity Index of 1 (CVI = 1.0), and thus remained in the pre-final version of the instrument. The instrument was pre-tested with seven caregivers of people with dementia, the majority of whom were women (57.1%), with a degree of kinship corresponding to sons/daughters (57.1%) and an average age of 55.2 (± 4.1) years. The caregivers considered it clear and understandable and made no suggestions for changes.</p><p><strong>Conclusion: </strong>The PAC scale was translated and culturally adapted for use by informal caregivers of people with dementia in Brazil. However, a psychometric analysis of the instrument is necessary to provide normative data for this population group.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 2","pages":"e2023325"},"PeriodicalIF":1.3,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10950309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isotemporal substitution analysis of time between sleep, sedentary behavior, and physical activity on depressive symptoms in older adults: a cross-sectional study.","authors":"Joilson Meneguci, Lucas Lima Galvão, Sheilla Tribess, Cíntia Aparecida Garcia Meneguci, Jair Sindra Virtuoso Júnior","doi":"10.1590/1516-3180.2023.0144.R2.04122023","DOIUrl":"10.1590/1516-3180.2023.0144.R2.04122023","url":null,"abstract":"<p><strong>Background: </strong>Compared to young individuals, older adults participate more in sedentary behavior (SB) and less in physical activity (PA). These behaviors are associated with numerous adverse health factors.</p><p><strong>Objective: </strong>The purpose of the study was to examine the hypothetical effects of substituting time spent sleeping, performing SB, and performing moderate-to-vigorous physical activity (MVPA) on depressive symptomatology in older adults.</p><p><strong>Design and setting: </strong>An analytical cross-sectional study employing exploratory survey methods was conducted in the city of Alcobaça in the state of Bahia, Brazil.</p><p><strong>Methods: </strong>The study included 473 older adults who answered a structured questionnaire during an interview. Exposure time to SB and PA level were assessed using the International Physical Activity Questionnaire, and depressive symptoms were analyzed using the short version of the Geriatric Depression Scale. An isotemporal replacement model was used to evaluate the effects of different SB sessions on depressive symptomatology.</p><p><strong>Results: </strong>An increase in the risk of depressive symptoms was observed when MVPA and sleep time were substituted for the same SB time at all times tested, with maximum values of 40% and 20%, respectively. Opposite substitution of MVPA and sleep time increments reduced the risk of depressive symptomatology by 28% and 17%, respectively.</p><p><strong>Conclusions: </strong>The results of the present study indicate that replacing SB with the same amount of sleep or MVPA may reduce depressive symptoms. The longer the reallocation time, the greater are the benefits.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 4","pages":"e2023144"},"PeriodicalIF":1.3,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10950321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case report of scrub typhus complicated by hypokalemia and multiple organ dysfunction syndrome.","authors":"Li Chen, Yi Deng, Peiying Huang, Sisi Lei, Shuling Liu, Weitao Lin, Zhishang Li, Jing Zeng, Miaochun Huang, Qiuping Huang, Qihua Wu, Haobo Zhang, Bojun Chen","doi":"10.1590/1516-3180.2023.0142.R1.08122023","DOIUrl":"10.1590/1516-3180.2023.0142.R1.08122023","url":null,"abstract":"<p><strong>Context: </strong>Scrub typhus, caused by Orientia tsutsugamushi, has a wide range of clinical manifestations, including meningoencephalitis, acute renal failure, pneumonitis, myocarditis, and septic shock. However, there are no documented cases of scrub typhus with hypokalemia. In this report, we present a case of scrub typhus with hypokalemia and multiple organ failure syndrome, highlighting the importance of electrolyte imbalance in patients with scrub typhus.</p><p><strong>Case report: </strong>A 59-year-old woman presented to the emergency department with abdominal pain that had been present for 1 day. On admission, the physical examination and laboratory test results indicated that the patient had renal, liver, and circulatory failure, and hypokalemia. She developed meningitis and disseminated intravascular coagulation during hospitalization. She recovered with appropriate management, and was discharged on day 17.</p><p><strong>Conclusion: </strong>This report highlights the potential for atypical presentations of scrub typhus, including a previously undocumented association with hypokalemia. Although the contribution of hypokalemia to the patient's clinical course remains uncertain, this case underscores the importance of considering electrolyte imbalance in the management of patients with scrub typhus. Further research is warranted to better understand the relationship between scrub typhus and electrolyte imbalance.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 4","pages":"e20230142"},"PeriodicalIF":1.3,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the effect of the structural model of active aging on the self-assessment of quality of life among older people: A cross-sectional and analytical study.","authors":"Nayara Gomes Nunes Oliveira, Alisson Fernandes Bolina, Vanderlei José Haas, Darlene Mara Dos Santos Tavares","doi":"10.1590/1516-3180.2022.0609.R1.230523","DOIUrl":"10.1590/1516-3180.2022.0609.R1.230523","url":null,"abstract":"<p><strong>Background: </strong>Although studies have examined the relationship between variables associated with active aging and quality of life (QoL), no studies have been identified to have investigated the effect of a structural model of active aging on QoL in a representative sample of older people in the community.</p><p><strong>Objective: </strong>To measure the domains and facets of QoL in older people and identify the effect of the structural model of active aging on the self-assessment of QoL.</p><p><strong>Design and setting: </strong>This cross-sectional analytical study included 957 older people living in urban areas. Data were collected from households using validated instruments between March and June 2018. Descriptive, confirmatory factor, and structural equation modeling analyses were performed.</p><p><strong>Results: </strong>Most older people self-rated their QoL as good (58.7%), and the highest mean scores were for the social relationships domain (70.12 ± 15.4) and the death and dying facet (75.43 ± 26.7). In contrast, the lowest mean scores were for the physical domains (64.41 ± 17.1) and social participation (67.20 ± 16.2) facets. It was found that active aging explained 50% of the variation in self-assessed QoL and directly and positively affected this outcome (λ = 0.70; P < 0.001).</p><p><strong>Conclusion: </strong>Active aging had a direct and positive effect on the self-assessment of QoL, indicating that the more individuals actively aged, the better the self-assessment of QoL.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 2","pages":"e2022609"},"PeriodicalIF":1.3,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aspects that facilitate access to care for viral hepatitis: An evaluative research.","authors":"Josué Souza Gleriano, Carlise Krein, Lucieli Dias Pedreschi Chaves","doi":"10.1590/1516-3180.2023.0078.R1.29112023","DOIUrl":"10.1590/1516-3180.2023.0078.R1.29112023","url":null,"abstract":"<p><strong>Background: </strong>Viral hepatitis is a major public health concern worldwide.</p><p><strong>Objectives: </strong>This study aimed to analyze the factors that facilitate access to care for viral hepatitis.</p><p><strong>Design and setting: </strong>Using a sequential mixed method, this evaluation research was conducted in the state of Mato Grosso, Brazil.</p><p><strong>Methods: </strong>Mapping of references and selection of regions were made based on the quantity and heterogeneity of services. The stakeholders, including the managers of the State Department of Health and professionals from reference services, were identified. Nine semi-structured interviews were conducted using content analysis and discussions guided by the dimensions of the analysis model of universal access to health services.</p><p><strong>Results: </strong>In the political dimension, decentralizing services and adhering to the Intermunicipal Health Consortium are highly encouraged. In the economic-social dimension, a commitment exists to allocate public funds for the expansion of referral services and subsidies to support users in their travel for appointments, medications, and examinations. In the organizational dimension, the availability of inputs for testing, definition of user flow, ease of scheduling appointments, coordination by primary care in testing, collaboration following the guidelines and protocols, and engagement in extramural activities are guaranteed. In the technical dimension, professionals actively commit to the service and offer different opening hours, guarantee the presence of an infectious physician, expand training opportunities, and establish intersectoral partnerships. In the symbolic dimension, professionals actively listen to the experiences of users throughout their care trajectory and demonstrate empathy.</p><p><strong>Conclusions: </strong>The results are crucial for improving comprehensiveness, but necessitate managerial efforts to enhance regional governance.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 4","pages":"e2023078"},"PeriodicalIF":1.3,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translational Medicine and Implementation Science.","authors":"Protásio Lemos da Luz, Paulo Manuel Pêgo-Fernandes","doi":"10.1590/1516-3180.2022.1416011123","DOIUrl":"10.1590/1516-3180.2022.1416011123","url":null,"abstract":"","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"141 6","pages":"e20231416"},"PeriodicalIF":1.3,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical condition and perceived fatigue in post-covid patients: An observational descriptive study.","authors":"Tamara Iturriaga, Fernanda Salazar-Pérez, Marta Casallo-Cerezo, Guillermo García-Pérez-de-Sevilla, Alicia Sosa-Pedreschi, Ignacio Diez-Vega, Marta Supervia, Olga Arroyo, Margarita Pérez-Ruiz","doi":"10.1590/1516-3180.2023.0167.R1.04122023","DOIUrl":"10.1590/1516-3180.2023.0167.R1.04122023","url":null,"abstract":"<p><strong>Background: </strong>Patients with severe coronavirus disease 2019 (COVID-19) often require hospital admission and experience sequelae such as chronic fatigue or low muscle mass.</p><p><strong>Objective: </strong>To analyze the functional capacity of a cohort of patients with severe acute respiratory syndrome coronavirus 2 who required hospitalization.</p><p><strong>Design and setting: </strong>An observational descriptive study was conducted on post-COVID-19 patients referred to the Rehabilitation Department of Gregorio Marañón Hospital (Madrid, SPAIN).</p><p><strong>Methods: </strong>Cardiorespiratory fitness, muscle strength, body composition, and perception of fatigue and dyspnea were analyzed. Furthermore, the existing correlations between clinical variables and physical conditions were analyzed.</p><p><strong>Results: </strong>Forty-two patients who required hospital admission (80 ± 22.45 days) or intensive care unit (ICU) admission (58 ± 10.52 days) were analyzed. They presented with decreased strength, respiratory capacity, and moderate-to-severe perceived fatigue. Additionally, an inverse correlation was found between right-handgrip strength and days in the ICU, as well as the 6-minute walk test for women. Similarly, strength and fitness were negatively associated with perceived fatigue.</p><p><strong>Conclusions: </strong>Post-COVID-19 patients showed low muscle function and low levels of physical fitness associated with high perceived fatigue.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"142 4","pages":"e2023167"},"PeriodicalIF":1.3,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}