RESUMO
Abstract Objective: The aim was to adapt an instrument that evaluates the relationship between young individuals and health professionals to the Brazilian population, which will be called the Escala de Avaliação de Vínculo entre Jovens e Profissionais de Saúde (Youth Connectedness to Provider scale). Method: The questionnaire known as the Youth Connectedness to Provider scale consists of seven Likert-like questions. The translation, back-translation, evaluation by ten specialists, and pre-test with 43 adolescents and young adults aged between 10 and 24 years were performed to assess the clarity and reliability of meanings. The content validity index was calculated for each question. Subsequently, the clinical validation was performed with 83 patients aged 10-24 years old and Cronbach's alpha coefficient was calculated. Results: A content validity index >0.8 (considered satisfactory) was obtained for all items analyzed by experts and adolescents. At the clinical validation, it showed a high internal consistency (Cronbach's alpha = 0.76). The questions showed a good correlation, except for the question about judgment (Spearman's rho = 0.03-0.19). Conclusions: The scale adaptation showed an adequate agreement rate at the translation evaluation and a good reliability index in the questions. This instrument provides information on strengths and topics that require more attention from professionals to improve the relationship with their patients; it can be a valuable parameter in assessing the medical consultation quality.
Assuntos
Humanos , Criança , Adolescente , Adulto , Adulto Jovem , Traduções , Pessoal de Saúde , Brasil , Inquéritos e Questionários , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: The aim was to adapt an instrument that evaluates the relationship between young individuals and health professionals to the Brazilian population, which will be called the Escala de Avaliação de Vínculo entre Jovens e Profissionais de Saúde (Youth Connectedness to Provider scale). METHOD: The questionnaire known as the Youth Connectedness to Provider scale consists of seven Likert-like questions. The translation, back-translation, evaluation by ten specialists, and pre-test with 43 adolescents and young adults aged between 10 and 24 years were performed to assess the clarity and reliability of meanings. The content validity index was calculated for each question. Subsequently, the clinical validation was performed with 83 patients aged 10-24 years old and Cronbach's alpha coefficient was calculated. RESULTS: A content validity index >0.8 (considered satisfactory) was obtained for all items analyzed by experts and adolescents. At the clinical validation, it showed a high internal consistency (Cronbach's alpha=0.76). The questions showed a good correlation, except for the question about judgment (Spearman's rho=0.03-0.19). CONCLUSIONS: The scale adaptation showed an adequate agreement rate at the translation evaluation and a good reliability index in the questions. This instrument provides information on strengths and topics that require more attention from professionals to improve the relationship with their patients; it can be a valuable parameter in assessing the medical consultation quality.
Assuntos
Pessoal de Saúde , Traduções , Adolescente , Adulto , Brasil , Criança , Humanos , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto JovemRESUMO
INTRODUCTION: User satisfaction assessment in mental health services is an important indicator of treatment quality. The objective of this study was to evaluate treatment satisfaction in a sample of inpatients with mental disorders and the associations between levels of satisfaction and clinical/sociodemographic variables. METHODS: This exploratory study investigated 227 psychiatric inpatients who answered the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and the Perception of Change Scale (EMP). SATIS scores were analyzed according to associations with clinical and sociodemographic data. Pearson correlations were used to correlate SATIS scores with other variables. RESULTS: We found a high degree of satisfaction with care at the psychiatric inpatient unit assessed. In general, patients rated maximum satisfaction for most items. The highest satisfaction scores were associated with patients receiving treatment through the Brazilian Unified Health System (SUS) and with less education. SATIS showed a moderate positive correlation with EMP. The worst evaluated dimension was physical facilities and comfort of the ward. CONCLUSION: Patients treated via SUS may be more satisfied than patients with private health insurance when treated in the same facility. The evaluation of treatment satisfaction can be used to reorganize services at psychiatric inpatient units.
Assuntos
Pacientes Internados/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Satisfação do Paciente , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Abstract Introduction User satisfaction assessment in mental health services is an important indicator of treatment quality. The objective of this study was to evaluate treatment satisfaction in a sample of inpatients with mental disorders and the associations between levels of satisfaction and clinical/sociodemographic variables. Methods This exploratory study investigated 227 psychiatric inpatients who answered the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and the Perception of Change Scale (EMP). SATIS scores were analyzed according to associations with clinical and sociodemographic data. Pearson correlations were used to correlate SATIS scores with other variables. Results We found a high degree of satisfaction with care at the psychiatric inpatient unit assessed. In general, patients rated maximum satisfaction for most items. The highest satisfaction scores were associated with patients receiving treatment through the Brazilian Unified Health System (SUS) and with less education. SATIS showed a moderate positive correlation with EMP. The worst evaluated dimension was physical facilities and comfort of the ward. Conclusion Patients treated via SUS may be more satisfied than patients with private health insurance when treated in the same facility. The evaluation of treatment satisfaction can be used to reorganize services at psychiatric inpatient units.
Resumo Introdução A avaliação da satisfação do usuário nos serviços de saúde mental é um importante indicador da qualidade do tratamento. O objetivo deste estudo foi avaliar a satisfação com o tratamento em uma amostra de pacientes internados com transtornos mentais e as associações entre os níveis de satisfação e variáveis clínicas/sociodemográficas. Métodos Este estudo exploratório investigou 227 pacientes psiquiátricos internados que responderam a Escala de Satisfação do Paciente com os Serviços de Saúde Mental (SATIS-BR) e a Escala de Percepção da Mudança (EMP). Os escores SATIS-BR foram analisados segundo associações com dados clínicos e sociodemográficos. Correlações de Pearson foram usadas para correlacionar escores SATIS com outras variáveis. Resultados Encontramos alto grau de satisfação com o atendimento na unidade de internação psiquiátrica avaliada. Em geral, os pacientes atribuíram satisfação máxima para a maioria dos itens. Os maiores escores de satisfação foram associados a pacientes em tratamento pelo Sistema Único de Saúde (SUS) e com menor escolaridade. A SATIS mostrou uma correlação positiva moderada com EMP. A pior dimensão avaliada foi associada às instalações físicas e conforto da enfermaria. Conclusão Pacientes com cobertura pelo SUS podem estar mais satisfeitos do que pacientes com planos privados de saúde quando tratados na mesma unidade. A avaliação da satisfação com o tratamento pode ser usada para reorganizar serviços em unidades de internação psiquiátrica.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Satisfação do Paciente , Pacientes Internados/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Brasil , Estudos Transversais , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: We aimed to evaluate whether radiotherapy causes changes in the mineral composition, hardness, and morphology of enamel and dentin of primary teeth. MATERIALS AND METHODS: Thirty specimens of primary teeth were subjected to radiotherapy. At baseline and after 1,080, 2,160, and 3,060 cGy, the specimens were subjected to microhardness, FT-Raman spectroscopy, and scanning electron microscopy (SEM) analysis. The pH of artificial saliva was determined, as were the calcium and phosphate concentrations. The data were subjected to the Shapiro-Wilk normality test, showed a nonnormal distribution, and were compared by the Kruskal-Wallis test. RESULTS: The results showed that the microhardness of the enamel surface decreased after 2,160 cGy (281.5 ± 58 kgf/mm2) when compared to baseline (323.6 ± 59.5 kgf/mm2) (p = 0.045). For dentin, the surface hardness decreased after 1,080 cGy (34.9 ± 11.4 kgf/mm2) and 2,160 cGy (26 ± 3.5 kgf/mm2) when compared to baseline (56.5 ± 7.7 kgf/mm2) (p < 0.0001). The mineral and organic contents of phosphate (p < 0.0001), carbonate (p < 0.0001), amide (p = 0.0002), and hydrocarbons (p = 0.0031) of enamel decreased after 3,060 cGy (5,178 ± 1,082, 3,868 ± 524, 999 ± 180, and 959 ± 168 kgf/mm2, respectively). For dentin, we noticed a growing increase in phosphate v2, amide, and hydrocarbon content after 1,080 cGy (8,210 ± 2,599, 5,730 ± 1,818, and 6,118 ± 1,807 kgf/mm2, respectively) and 2,160 cGy (1,0071 ± 2,547, 7,746 ± 1,916, and 8,280 ± 2,079 kgf/mm2, respectively) and a reduction after 3,060 cGy (6,782 ± 2,175, 3,558 ± 1,884, and 3,565 ± 1,867 kgf/mm2, respectively) (p < 0.0001). SEM images showed cracks on enamel and degradation of peritubular dentin. CONCLUSION: We concluded that radiotherapy caused a reduction in surface hardness, changed mineral and organic composition, and promoted morphological changes on the enamel and dentin of primary teeth.
Assuntos
Esmalte Dentário/química , Dentina/química , Minerais/química , Radioterapia/efeitos adversos , Dente Decíduo/efeitos da radiação , Esmalte Dentário/efeitos da radiação , Dentina/efeitos da radiação , Dureza , Humanos , Técnicas In Vitro , Microscopia Eletrônica de VarreduraRESUMO
OBJECTIVE: The objective of this study was to test if the Personality Inventory for DSM-5 (PID-5) is an adequate instrument to evaluate psychiatric inpatients' pathological personality traits. METHODS: Inpatients (n = 130; mean age: 38.5 years; 62.3% female; 63.9% single) answered the PID-5 after clinical improvement of their psychiatric symptoms. The mean scores of the DSM-5 personality domains, facets and profiles, and ICD-11 domain traits were compared with the mean scores of a Brazilian normative sample (n = 656). We investigated the diagnostic performance of the scales to identify individuals with and without psychopathology. RESULTS: The final sample included mainly diagnoses of mood disorders. Except for Antagonism and Disinhibition, all DSM-5 personality domains and most facets as well as almost all DSM-5 personality disorder profiles (except Narcissist) and ICD-11 trait domains (except Detachment and Dissociality) of the inpatients presented high differences compared with the normative sample. In general, the PID-5 scales presented a high negative predictive value and a low positive predictive value to identify individuals with severe psychopathology. DISCUSSION: This study found high scores of pathological personality traits in a sample of Brazilian psychiatric inpatients. The PID-5 may be a promising instrument to measure pathological personality traits among psychiatric inpatients. Methodological and sample size limitations may have influenced the results. © 2018 John Wiley & Sons, Ltd.
Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Classificação Internacional de Doenças/normas , Transtornos do Humor , Transtornos da Personalidade/diagnóstico , Inventário de Personalidade/normas , Personalidade , Escalas de Graduação Psiquiátrica/normas , Adulto , Brasil , Feminino , Hospitais Psiquiátricos , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/fisiopatologia , Personalidade/fisiologia , Transtornos da Personalidade/fisiopatologia , Adulto JovemRESUMO
Abstract Introduction: Assessment of the results of treatment for mental disorders becomes more complete when the patient's perspective is incorporated. Here, we aimed to evaluate the psychometric properties and application of the Perceived Change Scale - Patient version (PCS-P) in a sample of inpatients with mental disorders. Methods: One hundred and ninety-one psychiatric inpatients answered the PCS-P and the Patients' Satisfaction with Mental Health Services Scale (SATIS) and were evaluated in terms of clinical and sociodemographic data. An exploratory factor analysis (EFA) was performed and internal consistency was calculated. The clinical impressions of the patient, family, and physician were correlated with the patient's perception of change. Results: The EFA indicated a psychometrically suitable four-factor solution. The PCS-P exhibited a coherent relationship with SATIS and had a Cronbach's alpha value of 0.856. No correlations were found between the physician's clinical global impression of improvement and the patient's perception of change, although a moderate positive correlation was found between the patients' clinical global impression of improvement and the change perceived by the patient. Conclusions: The PCS-P exhibited adequate psychometric proprieties in a sample of inpatients with mental disorders. The patient's perception of change is an important dimension for evaluation of outcomes in the treatment of mental disorders and differs from the physician's clinical impression of improvement. Evaluation of positive and negative perceptions of the various dimensions of the patient's life enables more precise consideration of the patient's priorities and interests.
Resumo Introdução: A avaliação dos resultados do tratamento para transtornos mentais torna-se mais completa quando a perspectiva do paciente é incluída. O objetivo deste trabalho foi avaliar as propriedades psicométricas e a aplicação da Escala de Mudança Percebida - Versão do Paciente (EMP-P) em uma amostra de pacientes internados com transtornos mentais. Métodos: Um total de 191 pacientes psiquiátricos internados responderam a EMP-P e a Escala de Avaliação da Satisfação dos Usuários com os Serviços de Saúde Mental (SATIS), além de serem avaliados quanto a dados clínicos e sociodemográficos. Foi realizada análise fatorial exploratória (AFE) e calculada a consistência interna. As impressões clínicas do paciente, da família e do médico foram correlacionadas com a mudança percebida pelo paciente. Resultados: A AFE indicou uma solução de quatro fatores psicometricamente adequada. A EMP-P apresentou uma relação coerente com a SATIS e um alfa de Cronbach de 0,856. Não foi encontrada correlação entre impressão clínica global de melhora pelo médico e mudança percebida pelo paciente, embora uma correlação positiva moderada tenha sido observada entre impressão clínica global de melhora pelo paciente e mudança percebida pelo paciente. Conclusão: A EMP-P exibiu propriedades psicométricas adequadas em uma amostra de pacientes com transtornos mentais internados. A percepção de mudança pelo paciente é uma importante dimensão para a avaliação de resultados no tratamento de transtornos mentais e difere da impressão clínica de melhora do médico. A avaliação das percepções positivas e negativas das diversas dimensões da vida dos pacientes permite uma análise mais precisa de suas prioridades e interesses.
Assuntos
Humanos , Masculino , Feminino , Adulto , Percepção , Médicos/psicologia , Inquéritos e Questionários , Satisfação do Paciente , Pacientes Internados/psicologia , Transtornos Mentais/psicologia , Psicometria , Fatores Socioeconômicos , Tradução , Estudos Transversais , Análise Fatorial , Transtornos Mentais/terapia , Serviços de Saúde MentalRESUMO
INTRODUCTION:: Assessment of the results of treatment for mental disorders becomes more complete when the patient's perspective is incorporated. Here, we aimed to evaluate the psychometric properties and application of the Perceived Change Scale - Patient version (PCS-P) in a sample of inpatients with mental disorders. METHODS:: One hundred and ninety-one psychiatric inpatients answered the PCS-P and the Patients' Satisfaction with Mental Health Services Scale (SATIS) and were evaluated in terms of clinical and sociodemographic data. An exploratory factor analysis (EFA) was performed and internal consistency was calculated. The clinical impressions of the patient, family, and physician were correlated with the patient's perception of change. RESULTS:: The EFA indicated a psychometrically suitable four-factor solution. The PCS-P exhibited a coherent relationship with SATIS and had a Cronbach's alpha value of 0.856. No correlations were found between the physician's clinical global impression of improvement and the patient's perception of change, although a moderate positive correlation was found between the patients' clinical global impression of improvement and the change perceived by the patient. CONCLUSIONS:: The PCS-P exhibited adequate psychometric proprieties in a sample of inpatients with mental disorders. The patient's perception of change is an important dimension for evaluation of outcomes in the treatment of mental disorders and differs from the physician's clinical impression of improvement. Evaluation of positive and negative perceptions of the various dimensions of the patient's life enables more precise consideration of the patient's priorities and interests.
Assuntos
Pacientes Internados/psicologia , Transtornos Mentais/psicologia , Satisfação do Paciente , Percepção , Médicos/psicologia , Inquéritos e Questionários , Adulto , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Masculino , Transtornos Mentais/terapia , Serviços de Saúde Mental , Psicometria , Fatores Socioeconômicos , TraduçãoRESUMO
Background General Hospital Psychiatric Units have a fundamental importance in the mental health care systems. However, there is a lack of studies regarding the level of improvement of patients in this type of facility. Objective To assess factors related to good and poor outcomes in psychiatric inpatients using an index composed by clinical parameters easily measured. Methods Length of stay (LOS), Global Assessment of Functioning (variation and at discharge) and Clinical Global Impression (severity and improvement) were used to build a ten-point improvement index (I-Index). Records of psychiatric inpatients of a general hospital during an 18-month period were analyzed. Three groups (poor, intermediate and good outcomes) were compared by univariate and multivariate models according to clinical and sociodemographic variables. Results Two hundred and fifty patients were included, with a percentage in the groups with poor, regular and good outcomes of 16.4%, 59,6% and 24.0% respectively. Poor outcome at the discharge was associated mainly with lower education, transient disability, antipsychotics use, chief complaint behavioral change/aggressiveness and psychotic features. Multivariate analysis found a higher OR for diagnoses of psychotic disorders and personality disorders and others variables in relation to protective categories in the poor outcome group compared to the good outcome group. Discussion Our I-Index proved to be an indicator of that allows an easy and more comprehensive evaluation to assess outcomes of inpatients than just LOS. Different interventions addressed to conditions such as psychotic disorders and disruptive chief complaints are necessary.
Assuntos
Humanos , Masculino , Feminino , Hospitais Psiquiátricos , Tempo de Internação , Transtornos Mentais/diagnósticoRESUMO
INTRODUÇÃO: Reconstruções de defeitos complexos na face constituem um desafio para os cirurgiões. Após ressecção da lesão, o reparo nasal é difícil, já que possui uma variedade de tecidos e área local doadora reduzida para reconstrução. Já as lesões de lábio possuem como principal dificuldade a restauração da função, priorizando a integridade da estrutura esfincteriana, a continência oral, a abertura bucal e a sensibilidade. Entre as alternativas para reconstrução dessas áreas, podemos optar por retalhos locais, entre os quais o nasogeniano. OBJETIVO: Analisar desfechos de reconstrução nasal e de lábio superior em dois tempos cirúrgicos, utilizando retalho nasogeniano, após defeito complexo causado por ressecção de carcinoma espinocelular (CEC). RELATO DO CASO: Paciente do gênero feminino, 56 anos, apresentou CEC de progressão avançada em região nasal da columela, terço anterior do septo e parte do lábio superior. A paciente foi submetida à reconstrução com retalho nasogeniano e, em segundo momento cirúrgico, ao enxerto de cartilagem costal para reconstrução de columela. Apresenta evolução com boa integração e viabilidade dos enxertos e retalhos. O resultado estético foi satisfatório. CONCLUSÃO: A utilização de retalho nasogeniano como opção terapêutica para a reconstrução parcial de nariz e de lábio superior apresentou desfechos funcionais/estéticos favoráveis. Além disso, a segmentação do procedimento cirúrgico traz segurança na utilização dos retalhos locais, principalmente em indivíduos de difícil cicatrização.
INTRODUCTION: Reconstruction of complex facial defects is a challenge for surgeons. After the excision of a lesion, nasal reconstruction is challenging because of the variety of tissues involved and the reduced local donor area for reconstruction. On the other hand, a major difficulty in the reconstruction of lip lesions is restoration of function, with the priority being the maintenance of the integrity of the sphincter structure, oral continence, mouth opening, and sensitivity. Among the alternatives for the reconstruction of these areas are local flaps, including the nasolabial flap. AIM: To analyze the outcome of nasal and upper lip reconstruction performed in two surgical stages, by using a nasolabial flap for complex defects resulting from the resection of squamous cell carcinoma (SCC). CASE REPORT: A 56-year-old female patient presented with advanced SCC in the nasal region of the columella, anterior third of the septum, and part of the upper lip. She underwent reconstruction with a nasolabial flap and, in a second surgical procedure, with a costal cartilage graft for the reconstruction of the columella. The procedures resulted in good integration and viability of grafts and flaps. The aesthetic result was satisfactory. CONCLUSION: The use of a nasolabial flap as a therapeutic option for the partial reconstruction of the nose and upper lip produces favorable functional and aesthetic outcomes. In addition, the division of the surgical procedure into stages provides safety in the use of local flaps, particularly in patients with poor healing.