ABSTRACT OBJECTIVE To show the implementation process of IPT-G in primary care, including facilitating and obstructing factors, implementation strategies, and training and supervision of primary care professionals. METHODS Quantitative (cross-sectional and longitudinal) analysis of pre and post-knowledge tests; qualitative analyses of the training courses; patient recruitment; conduction of IPT-G sessions; supervision of IPT-G therapists; application of a semi-structured questionnaire to assess, investigate, and develop strategies against the identified barriers. RESULTS About 120 clinicians answered the pre-test; 84 completed the post-test. Pre- and post-test scores of IPT-G knowledge were significantly different. Twenty initially trained clinicians completed additional supervision in IPT-G. Qualitative analysis identified twelve barriers and six facilitators to IPT-G implementation in individual, organizational, and systemic contexts. CONCLUSIONS Implementation of IPT-G in primary care is a complex process with several steps. In the first step, health professionals were successfully trained in IPT-G. However, subsequent steps were more complex. Therefore, careful planning of IPT-G implementation is essential to maximize the success of this innovation.

ABSTRACT OBJECTIVE To show the implementation process of IPT-G in primary care, including facilitating and obstructing factors, implementation strategies, and training and supervision of primary care professionals. METHODS Quantitative (cross-sectional and longitudinal) analysis of pre and post-knowledge tests; qualitative analyses of the training courses; patient recruitment; conduction of IPT-G sessions; supervision of IPT-G therapists; application of a semi-structured questionnaire to assess, investigate, and develop strategies against the identified barriers. RESULTS About 120 clinicians answered the pre-test; 84 completed the post-test. Pre- and post-test scores of IPT-G knowledge were significantly different. Twenty initially trained clinicians completed additional supervision in IPT-G. Qualitative analysis identified twelve barriers and six facilitators to IPT-G implementation in individual, organizational, and systemic contexts. CONCLUSIONS Implementation of IPT-G in primary care is a complex process with several steps. In the first step, health professionals were successfully trained in IPT-G. However, subsequent steps were more complex. Therefore, careful planning of IPT-G implementation is essential to maximize the success of this innovation.

Abstract Introduction Individuals with major depressive disorder (MDD) face more barriers to engagement in sports and exercise interventions. Evaluating clinical and demographic factors associated with adherence to sports and exercise among MDD outpatients could support development of new options and strategies to increase their participation. Methods In a cross-sectional study, 268 depressed outpatients were evaluated (83.51% females; mean age = 50.74 [standard deviation {SD} = 10.39]). Sports and exercise participation were assessed using a question about participation frequency during the previous month. Clinical and demographic factors were evaluated. Linear regression was used to identify predictors of participation in sports and exercise. Results MDD patients with mild symptoms of depression (odds ratio [OR] = 2.42; 95% confidence interval [95%CI] 1.00, 5.88; p = 0.04) and patients with mild to moderate symptoms (OR = 3.96; 95%CI 1.41, 11.15; p = 0.009) were more likely to engage regularly in sports and exercise than patients with more severe depression. Moreover, smoking (OR = 0.23; 95%CI 0.67, 0.80; p = 0.007) and being divorced (OR = 0.22; 95%CI 0.57, 0.86; p = 0.03) were associated with lower rates of engagement in sports and exercise. Conclusion Our findings indicate a significant association between clinical and demographic factors and participation in sports and exercise among MDD outpatients.

Resumo Objetivo Validar o instrumento de rastreamento de sintomas pré-menstruais (PSST) em relação ao relato diário da gravidade dos problemas (DRSP) para o diagnóstico de síndrome pré-menstrual (SPM) e de transtorno disfórico pré-menstrual (TDPM). Métodos Um estudo transversal com 127 mulheres entre 20 e 45 anos com queixas de SPM. As mulheres foram avaliadas quanto ao peso, à altura e ao índice de massa corporal (IMC). Depois de excluir o diagnóstico de depressão pelo questionário de avaliação de distúrbios mentais para atenção primária (PRIME-MD), o PSST foi respondido e as mulheres receberam orientações sobre como preencher o DRSP por dois meses. A concordância entre os dois questionários foi conduzida através do índice de Kapa (k) e pelo PABAK. Resultados Duzentos e oitenta e duas mulheres com critérios elegíveis responderam ao PSST. O DRSP foi preenchido por dois ciclos por 127 mulheres. As porcentagens de mulheres com diagnósticos de SPM e de TDPM pelo DRSP foram de 74,8% e 3,9%, respectivamente; pelo PSST, as porcentagens foram de 41,7% e 34,6%, respectivamente. O número de pacientes consideradas "normais" (com sintomas abaixo do necessário para o diagnóstico de SPM) foi similar nos dois questionários. Análises demonstraram não haver concordância entre ambos os instrumentos para os resultados diagnósticos de SPM e TDPM (Kappa = 0,12, coeficiente de PABAK = 0,39). Para o diagnóstico de SPM/TDPM, o PSST apresentou uma alta sensibilidade (79%) e baixa especificidade (33,3%). Conclusão O PSST é considerado uma ferramenta de triagem. Conclui-se que casos positivos de SPM/TDPM pelo PSST devem ser melhor investigados pelo DRSP para confirmar o diagnóstico.

Abstract Objective To validate the premenstrual symptoms screening tool (PSST) in relation to the daily record of severity of problems (DRSP) for premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) diagnoses. Methods A cross-sectional study with 127 women (20 45 years) with PMS complaints. The women were evaluated in terms of weight, height and body mass index (BMI). After using the primary care evaluation of mental disorders (PRIME-MD) questionnaire to exclude the diagnosis of depression, the PSST was completed and the women were instructed to fill out the DRSP for two consecutive menstrual cycles. The agreement between the two questionnaires was assessed by the Kappa (k) and the prevalence-adjusted, bias-adjusted kappa (PABAK) values. Results Two-hundred and eighty-two women met the eligibility criteria and answered the PSST. The DRSP was completed for two cycles by 127 women. The percentages of women with PMS and PMDD diagnoses by the DRSP were 74.8% and 3.9% respectively; by PSST, the percentages were41.7% and 34.6% respectively. The number of patients considered "normal" (with symptoms below the threshold for the diagnosis of PMS) was similar in both questionnaires. There was no agreement (Kappa = 0.12) in the results of PMS/ PMDD diagnosis (the PABAK coefficient confirmed this result = 0.39). The PSST had a high sensitivity (79%) and a low specificity (33.3%) for PMS/PMDD diagnosis. Conclusion The PSST should be considered a diagnostic screening tool. Positive PMS/PMDD cases by PSST should be further evaluated by DRSP to confirm the diagnosis.

Resumo Fundamento: A espiritualidade pode influenciar a maneira com que os pacientes lidam com sua doença. Objetivos: Avaliamos a possibilidade de a espiritualidade influenciar a adesão ao tratamento de pacientes ambulatoriais com insuficiência cardíaca. Métodos: Estudo transversal com pacientes ambulatoriais com insuficiência cardíaca, cuja adesão ao tratamento multidisciplinar foi avaliada. Os pacientes foram avaliados sobre qualidade de vida, depressão, religiosidade e espiritualidade, utilizando questionários validados. Foram obtidas correlações entre adesão e variáveis psicossociais de interesse. Modelos de regressão logística exploraram preditores independentes de adesão. Resultados: Cento e trinta pacientes (idade 60 ± 13 anos; 67% masculinos) foram entrevistados. Observou-se adequado escore de adesão em 38,5% dos pacientes. Nem a depressão ou a religiosidade foram correlacionados à adesão, quando avaliados separadamente. É interessante notar que quando a espiritualidade foi avaliada por ambos, o somatório total de score (r = 0,26; p = 0,003) e os domínios específicos, ela estava positivamente correlacionada à adesão. Por fim, a combinação de espiritualidade, religiosidade e crenças pessoais mostrou-se um preditor independente de adesão quando ajustado às características demográficas, clínicas e a instrumentos psicossociais. Conclusão: Espiritualidade, religiosidade e crenças pessoais foram as únicas variáveis consistentemente associadas à adesão em relação à medicação em uma coorte de pacientes ambulatoriais com insuficiência cardíaca. Nossos dados sugerem que abordar adequadamente esses aspectos no cuidado com o paciente pode auxiliar a melhorar o padrão de adesão no complexo tratamento da insuficiência cardíaca.

Abstract Background: Spirituality may influence how patients cope with their illness. Objectives: We assessed whether spirituality may influence adherence to management of outpatients with heart failure. Methods: Cross sectional study enrolling consecutive ambulatory heart failure patients in whom adherence to multidisciplinary treatment was evaluated. Patients were assessed for quality of life, depression, religiosity and spirituality utilizing validated questionnaires. Correlations between adherence and psychosocial variables of interest were obtained. Logistic regression models explored independent predictors of adherence. Results: One hundred and thirty patients (age 60 ± 13 years; 67% male) were interviewed. Adequate adherence score was observed in 38.5% of the patients. Neither depression nor religiosity was correlated to adherence, when assessed separately. Interestingly, spirituality, when assessed by both total score sum (r = 0.26; p = 0.003) and by all specific domains, was positively correlated to adherence. Finally, the combination of spirituality, religiosity and personal beliefs was an independent predictor of adherence when adjusted for demographics, clinical characteristics and psychosocial instruments. Conclusion: Spirituality, religiosity and personal beliefs were the only variables consistently associated with compliance to medication in a cohort of outpatients with heart failure. Our data suggest that adequately addressing these aspects on patient’s care may lead to an improvement in adherence patterns in the complex heart failure management.

OBJETIVO Analisar as evidências de validade e fidedignidade da versão para o português brasileiro da Quality of Care Scale na perspectiva de pessoas com incapacidades físicas e intelectuais. MÉTODOS Participaram do estudo 162 pessoas com incapacidades físicas e 156 com incapacidades intelectuais em Porto Alegre e região metropolitana, 2008. A psicometria clássica foi utilizada para analisar as duas amostras independentemente. As hipóteses para evidências de validade de critério do tipo concorrente foram avaliadas com teste de Mann-Whitney. A análise de componentes principais foi utilizada para exploração dos modelos fatoriais. Evidências de fidedignidade foram calculadas com α de Cronbach para escalas e subescalas. A fidedignidade teste-reteste para pessoas com incapacidades intelectuais foi analisada pelo coeficiente de correlação intraclasse e teste de Willcoxon. RESULTADOS Os componentes principais no grupo de pessoas com incapacidades físicas replicou o modelo original apresentado em solução aos dados internacionais do projeto. Foram encontradas evidências de validade discriminante e de fidedignidade teste-reteste. CONCLUSÕES O modelo fatorial transcultural encontrado na amostra internacional do projeto parece adequado para as amostras testadas neste estudo, especialmente a de incapacidades físicas. Depressão, dor, satisfação com a vida e incapacidade parecem ter papel mediador na avaliação da qualidade de cuidado. Pesquisas adicionais são necessárias para o acréscimo de evidências às validades dos instrumentos.

OBJECTIVE To analyze evidence of the validity and reliability of a Brazilian Portuguese version of the Quality of Care Scale from the perspective of people with physical and intellectual disabilities. METHODS There were 162 people with physical disabilities and 156 with intellectual disabilities from Porto Alegre and metropolitan region, who participated in the study in 2008. Classical psychometrics was used to independently analyze the two samples. Hypotheses for evidence of criterion validity (concurrent type) were tested with the Mann-Whitney test for non-normal distributions. Principal components analysis was used to explore factorial models. Evidence of reliability was calculated with Cronbach alpha for the scales and subscales. Test-retest reliability was analyzed for individuals with intellectual disabilities through intra-class correlation coefficient and the Willcoxon test. RESULTS The principal components in the group with physical disabilities replicated the original model presented as a solution to the international project data. Evidence of discriminant validity and test-retest reliability was found. CONCLUSIONS The transcultural factor model found within the international sample project seems appropriate for the samples investigated in this study, especially the physical disabilities group. Depression, pain, satisfaction with life and disability may play a mediating role in the evaluation of quality of care. Additional research is needed to add to evidence of the validity of the instruments.

OBJETIVO Analisar as evidências de validade e fidedignidade da versão para o português brasileiro da Quality of Care Scale na perspectiva de pessoas com incapacidades físicas e intelectuais.MÉTODOS Participaram do estudo 162 pessoas com incapacidades físicas e 156 com incapacidades intelectuais em Porto Alegre e região metropolitana, 2008. A psicometria clássica foi utilizada para analisar as duas amostras independentemente. As hipóteses para evidências de validade de critério do tipo concorrente foram avaliadas com teste de Mann-Whitney. A análise de componentes principais foi utilizada para exploração dos modelos fatoriais. Evidências de fidedignidade foram calculadas com α de Cronbach para escalas e subescalas. A fidedignidade teste-reteste para pessoas com incapacidades intelectuais foi analisada pelo coeficiente de correlação intraclasse e teste de Willcoxon.RESULTADOS Os componentes principais no grupo de pessoas com incapacidades físicas replicou o modelo original apresentado em solução aos dados internacionais do projeto. Foram encontradas evidências de validade discriminante e de fidedignidade teste-reteste.CONCLUSÕES O modelo fatorial transcultural encontrado na amostra internacional do projeto parece adequado para as amostras testadas neste estudo, especialmente a de incapacidades físicas. Depressão, dor, satisfação com a vida e incapacidade parecem ter papel mediador na avaliação da qualidade de cuidado. Pesquisas adicionais são necessárias para o acréscimo de evidências às validades dos instrumentos.

OBJECTIVE To analyze evidence of the validity and reliability of a Brazilian Portuguese version of the Quality of Care Scale from the perspective of people with physical and intellectual disabilities.METHODS There were 162 people with physical disabilities and 156 with intellectual disabilities from Porto Alegre and metropolitan region, who participated in the study in 2008. Classical psychometrics was used to independently analyze the two samples. Hypotheses for evidence of criterion validity (concurrent type) were tested with the Mann-Whitney test for non-normal distributions. Principal components analysis was used to explore factorial models. Evidence of reliability was calculated with Cronbach alpha for the scales and subscales. Test-retest reliability was analyzed for individuals with intellectual disabilities through intra-class correlation coefficient and the Willcoxon test.RESULTS The principal components in the group with physical disabilities replicated the original model presented as a solution to the international project data. Evidence of discriminant validity and test-retest reliability was found.CONCLUSIONS The transcultural factor model found within the international sample project seems appropriate for the samples investigated in this study, especially the physical disabilities group. Depression, pain, satisfaction with life and disability may play a mediating role in the evaluation of quality of care. Additional research is needed to add to evidence of the validity of the instruments.

O estudo objetivou revisar a produção científica sobre a qualidade de vida relacionada à saúde (QVRS) de surdos. Trata-se de uma revisão integrativa, realizada na Biblioteca Virtual em Saúde, PubMed e Portal de periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes). Os resultados indicam que sintomas de ansiedade e depressão são mais acentuados nos surdos e podem estar relacionados a dificuldades de comunicação. As pessoas que vivenciam problemas de comunicação evitam novas relações sociais, e isso pode aumentar o isolamento social e reduzir a QVRS. Para os surdos que se comunicam pela Língua de Sinais, a QVRS só pode ser efetivamente avaliada por instrumentos traduzidos e adaptados em sua língua. Conclui-se que a surdez tem um impacto negativo sobre a qualidade de vida relacionada à saúde (QVRS) de pessoas surdas.

The purpose of this study was to review the scientific production on the health-related quality of life (HRQOL) of deaf people. This was an integrative review carried out in the Virtual Health Library, PubMed and CAPES (Coordination Office for Improvement of Higher Education Personnel) periodicals portal. The results indicated that anxiety and depression symptoms are greater among deaf people and may be related to difficulties in communication. People who experience communication problems avoid new social relationships and this may increase social isolation and diminish HRQOL. For deaf people who communicate in sign language, HRQOL can only be effectively evaluated by instruments that have been translated and adapted to their language. In conclusion, deafness has a negative impact on these individuals’ HRQOL.

El objetivo del estudio fue revisar la producción científica sobre la Calidad de Vida Relacionada con la Salud (QVRS, por sus siglas en portugués) de los sordos. Se trata de una revisión de integración realizada en la Biblioteca Virtual en Salud, PubMed y Portal de periódicos de la Coordinación de Perfeccionamiento de Personal de Nivel Superior (Capes). Los resultados indican que los síntomas de ansiedad y depresión son más acentuados en los sordos y pueden estar relacionados con dificultades de comunicación. Las personas que tienen problemas de comunicación evitan nuevas relaciones sociales y eso puede aumentar el aislamiento social y reducir la QVRS. Para los sordos que se comunican por la Lengua de Signos, la QVRS solamente puede evaluarse efectivamente por medio de instrumentos traducidos y adaptados a su lengua. Se concluye que la sordera causa un impacto negativo sobre la QVRS de los sordos.

O estudo objetivou revisar a produção científica sobre a qualidade de vida relacionada à saúde (QVRS) de surdos. Trata-se de uma revisão integrativa, realizada na Biblioteca Virtual em Saúde, PubMed e Portal de periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes). Os resultados indicam que sintomas de ansiedade e depressão são mais acentuados nos surdos e podem estar relacionados a dificuldades de comunicação. As pessoas que vivenciam problemas de comunicação evitam novas relações sociais, e isso pode aumentar o isolamento social e reduzir a QVRS. Para os surdos que se comunicam pela Língua de Sinais, a QVRS só pode ser efetivamente avaliada por instrumentos traduzidos e adaptados em sua língua. Conclui-se que a surdez tem um impacto negativo sobre a qualidade de vida relacionada à saúde (QVRS) de pessoas surdas.

The purpose of this study was to review the scientific production on the health-related quality of life (HRQOL) of deaf people. This was an integrative review carried out in the Virtual Health Library, PubMed and CAPES (Coordination Office for Improvement of Higher Education Personnel) periodicals portal. The results indicated that anxiety and depression symptoms are greater among deaf people and may be related to difficulties in communication. People who experience communication problems avoid new social relationships and this may increase social isolation and diminish HRQOL. For deaf people who communicate in sign language, HRQOL can only be effectively evaluated by instruments that have been translated and adapted to their language. In conclusion, deafness has a negative impact on these individuals’ HRQOL.

El objetivo del estudio fue revisar la producción científica sobre la Calidad de Vida Relacionada con la Salud (QVRS, por sus siglas en portugués) de los sordos. Se trata de una revisión de integración realizada en la Biblioteca Virtual en Salud, PubMed y Portal de periódicos de la Coordinación de Perfeccionamiento de Personal de Nivel Superior (Capes). Los resultados indican que los síntomas de ansiedad y depresión son más acentuados en los sordos y pueden estar relacionados con dificultades de comunicación. Las personas que tienen problemas de comunicación evitan nuevas relaciones sociales y eso puede aumentar el aislamiento social y reducir la QVRS. Para los sordos que se comunican por la Lengua de Signos, la QVRS solamente puede evaluarse efectivamente por medio de instrumentos traducidos y adaptados a su lengua. Se concluye que la sordera causa un impacto negativo sobre la QVRS de los sordos.

Resgata, contextualiza e caracteriza os aspectos sócio-históricos e culturais da comunidade surda que usa a Língua Brasileira de Sinais com enfoque no modelo socioantropológico. O objetivo deste estudo foi realizar a revisão bibliográfica em livros-textos e artigos científicos disponíveis na Biblioteca Virtual de Saúde, independentemente da data de publicação. Foram encontrados 102 artigos e 53 livros, dos quais 33 livros-textos e 26 artigos (quatro da base de dados Lilacs e 22 da Medline) constituíram a amostra. Hoje, em contraste com o passado, há leis que asseguram o direito de comunicação e atendimento por meio da Língua Brasileira de Sinais. É urgente a repercussão, aceitação e inserção, nas políticas de saúde, do que estabelecem as leis brasileiras.

This work redeems, contextualizes and features the social, historical and cultural aspects of the deaf community that uses the Brazilian Sign Language focusing on the social and anthropological model. The scope of this study was to conduct a bibliographical review in scientific textbooks and articles available in the Virtual Health Library, irrespective of the date of publication. 102 articles and 53 books were located, including 33 textbooks and 26 articles (four from the Lilacs database and 22 from the Medline database) that constituted the sample. Today, in contrast with the past, there are laws that guarantee the right to communication and attendance by means of the Brazilian Sign Language. The repercussion, acceptance and inclusion in health policies of the decrees enshrined in Brazilian laws is a major priority.

Objective: To use principal component analysis (PCA) to test the hypothesis that the items of the Hamilton Depression Scale (HAM-D17) have been selected to reflect depression disability, whereas some of the items are specific for sub-typing depression into typical vs. atypical depression. Method: Our previous study using exploratory factor analysis on HAM-D17 has been re-analyzed with PCA and the results have been compared to a dataset from another randomized prospective study. Results: PCA showed that the first principal component was a general factor covering depression disability with factor loadings very similar to those obtained in the STAR*D study. The second principal component was a bi-directional factor contrasting typical vs. atypical depression symptoms. Varimax rotation gave no new insight into the factor structure of HAM-D17. Conclusion: With scales like the HAM-D17, it is very important to make a proper clinical interpretation of the PCA before attempting any form of exploratory factor analysis. For the HAM-D17, our results indicate that profile scores are needed because the total score of all 17 items in the HAM-D17 does not give sufficient information.