Objective: to evaluate the association between quality of life and presence of symptoms of depression, anxiety, and stress in college students in the health area. Method: cross-sectional study that included 321 students from undergraduate courses in the health area. Quality of life was measured using the World Health Organization scale, abbreviated version, in the physical, psychological, social relations and environment domains, and symptoms were assessed by the depression, anxiety and stress scale. Multivariate analysis was performed using robust linear regression to evaluate the association between quality of life and symptoms. Results: a negative association was observed between the quality of life and depression symptoms in all domains, while anxiety symptoms showed a negative association in the environment domain, and stress symptoms had a negative association in the psychological domain. Symptom severity was unfavorably associated with quality of life, that is, the greater the symptom severity, the lower the mean scores in all domains. Conclusion: symptoms of depression, anxiety, and stress were prevalent and had a negative impact on students’ quality of life, especially in the presence of depressive symptoms. The decrease in scores was significantly associated with the severity of symptoms.

Objetivo: evaluar la asociación entre la calidad de vida y la presencia de síntomas de depresión, ansiedad y estrés en estudiantes universitarios del área de la salud. Método: estudio transversal que incluyó a 321 estudiantes de carreras del área de la salud. La calidad de vida se midió mediante la escala de la Organización Mundial de la Salud, versión abreviada, en los dominios físico, psicológico, relaciones sociales y ambiente, y los síntomas se evaluaron por la escala de depresión, ansiedad y estrés. Se realizó un análisis multivariante por medio de regresión lineal robusta para evaluar la asociación entre la calidad de vida y los síntomas presentados. Resultados: se observó una asociación negativa entre la calidad de vida y los síntomas de depresión en todos los dominios, mientras que los síntomas de ansiedad tuvieron una asociación negativa en el dominio ambiente, y los síntomas de estrés tuvieron una asociación negativa en el dominio psicológico. La gravedad de los síntomas se asoció desfavorablemente con la calidad de vida, es decir, cuanto mayor la gravedad de los síntomas, menores las puntuaciones medias en todos los dominios. Conclusión: los síntomas de depresión, ansiedad y estrés fueron prevalentes e impactaron negativamente en la calidad de vida de los estudiantes, especialmente en presencia de síntomas depresivos. Las puntuaciones disminuidas se asociaron significativamente con la gravedad de los síntomas.

Objetivo: avaliar a associação entre qualidade de vida e presença de sintomas de depressão, ansiedade e estresse em estudantes universitários da área da saúde. Método: estudo transversal que incluiu 321 estudantes de cursos de graduação da área da saúde. A qualidade de vida foi mensurada por meio da escala da Organização Mundial da Saúde, versão abreviada, nos domínios físico, psicológico, relações sociais e meio ambiente, e os sintomas avaliados pela escala de depressão, ansiedade e estresse. Foi realizada análise multivariada utilizando regressão linear robusta para avaliar a associação entre qualidade de vida e sintomas apresentados. Resultados: observou- se associação negativa entre qualidade de vida e sintomas de depressão em todos os domínios, enquanto os sintomas de ansiedade apresentaram associação negativa no domínio meio ambiente, e os sintomas de estresse tiveram associação negativa no domínio psicológico. A gravidade dos sintomas associou-se de forma desfavorável com a qualidade de vida, ou seja, quanto maior a gravidade dos sintomas, menor a média dos escores em todos os domínios. Conclusão: sintomas de depressão, ansiedade e estresse mostraram-se prevalentes e com impacto negativo na qualidade de vida dos estudantes, principalmente na presença de sintomas depressivos. A diminuição dos escores foi significativamente associada à gravidade dos sintomas.

This is a multicenter, cross-sectional study carried out with students regularly enrolled in undergraduate courses at eight Brazilian IFES. Data collection was conducted between October 2021 and February 2022 using an online self-completed questionnaire, which addressed sociodemographic and academic characteristics, lifestyle habits, and health conditions. Symptoms of anxiety and depression were assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Variables were analyzed descriptively using frequency distribution and Pearson’s chi-square test. To estimate the prevalence of symptoms of anxiety and depression, the proportion and 95% confidence interval (95%CI) were used. The level of adopted statistical significance was 5%.

Abstract Background Controlling blood pressure and glycemic levels is a challenge that requires innovative solutions. Objective To assess the feasibility of implementing a text message intervention among low-income primary care patients, as well as to assess self-reported behavioral change. Methods A set of 200 text messages was developed on healthy eating, physical activity, adherence, and motivation. Participants from Vale do Mucuri, MG, Brazil diagnosed with diabetes or hypertension or undergoing screening for those diseases, received 5 to 8 messages per week for 6 months. They answered a questionnaire to report their satisfaction and behavioral changes. Results Of the 136 patients, 117 (86.0%) answered the questionnaire. Most reported that the messages were very useful (86.3%), easy to understand (90.6%), and were very helpful for behavioral change (65.0%); 84.6% reported that they had started eating healthier. The most frequent reported lifestyle changes were: improved diet quality (85.5%), reduced portions (65.8%), and weight loss (56.4%). The majority of patients shared the messages (60.7%) with family or other acquaintances, considered the number of messages to be adequate (89.7%) and would recommend the program to others (95.7%). Conclusion An intervention based on text messages to promote behavioral change in patients with hypertension or diabetes in primary care is feasible in low-resource settings. Future studies are needed to assess the program’s long-term effects on clinical outcomes.

ABSTRACT Numerous tests employed to predict cardiac and functional status are expensive and not widely accessible for a considerable number of patients, particularly those diagnosed with Chagas disease (CD) residing in remote and endemic regions. To date, there is no knowledge of studies that have validated instruments that address functionality in an expanded way, including the biopsychosocial factors in patients with CD. This study aims to evaluate the psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS 2.0), in its 12-item shortened version (WHODAS-12) when applied to patients with CD. This is a cross-sectional study of a prospective cohort that follows individuals with CD (SaMi-Trop). Data collection took place between October 2019 and March 2020. In the interviews, sociodemographic information, life habits, clinical information, and indicators of disability measured by WHODAS-12 were collected. Descriptive analysis, internal consistency and construct validity of the instrument were performed. A total of 628 patients with CD were interviewed, most were women (69.5%), their mean age was of 57 years, and most declared an average self-perception of health (43.4%). The 12 items of WHODAS-12 were distributed into three factors, which together account for 61% of the variance. The Kaiser–Meyer–Olkin (KMO) index was 0.90, indicating adequacy of the sample for factor analysis. The internal consistency of the global scale showed alpha = 0.87. The percentage of incapacity was 16.05%, indicating mild incapacity for the evaluated patients. WHODAS-12 is a valid and reliable measure to assess the disability of the Brazilian population with CD.

ABSTRACT Background: Chagas disease (ChD) is a neglected tropical disease that is caused by the protozoan parasite Trypanosoma cruzi and can negatively impact quality of life (QoL). This study aimed to assess and compare QoL between individuals with and without ChD. Methods: This cross-sectional study was performed within a concurrent cohort study (REDS). The participants were derived from two blood donation centers: São Paulo capital and Montes Claros, Minas Gerais, Brazil. Participants with ChD were identified in blood donations by serological diagnosis between 2008 and 2010, and those without ChD were donors with negative serology identified during the same period. QoL was assessed using the World Health Organization Quality of Life-BREF questionnaire. Logistic regression was used to compare sociodemographic and clinical characteristics between the groups, and mean, standard deviation, and beta regression were used to compare QoL. Results: In total, 611 individuals participated in the study (328 with ChD and 283 without ChD). Participants with ChD had lower QoL in the physical (p=0.02) and psychological (p<0.01) domains than did individuals without CD. Conclusions: Individuals with ChD had worse QoL perceptions. These results provide a comprehensive understanding of the impact of ChD on individuals' QoL, while also highlighting potential opportunities for improving the care and treatment of those affected.

ABSTRACT Objective: to evaluate the quality of life (QOL) and the presence of symptoms related to depression, anxiety, and stress among students in the healthcare field, in comparison to the period before the COVID-19 pandemic. Methods: A comparative cross-sectional research was conducted at a Brazilian public university. QOL was assessed using the WHOQOL-bref scale, while symptoms of depression, anxiety, and stress were evaluated using the DASS-21 scale. Descriptive and inferential analyses were employed to compare the two time periods. Results: A total of 355 students participated in this study. During the pandemic, there were significant increases in severe depression symptoms (15.1% versus 24.8%), moderate anxiety (18.3% versus 29.4%), and moderate stress (40.9% versus 53.8%) observed among the participants. Additionally, a significant reduction in QOL was noted, particularly in the domain of social relationships (65.2 versus 59.6, p-value 0.029). Conclusion: The study highlights a deterioration in both the quality of life and the mental health of healthcare students during the COVID-19 pandemic.

RESUMEN Objetivo: Evaluar la calidad de vida (CV) y la presencia de síntomas de depresión, ansiedad y estrés en estudiantes del área de la salud, en comparación con el período previo a la pandemia de COVID-19. Métodos: Investigación transversal comparativa realizada en una universidad pública brasileña. La CV se evaluó utilizando la escala WHOQOL-bref, mientras que los síntomas de depresión, ansiedad y estrés se evaluaron utilizando la escala DASS-21. Se emplearon análisis descriptivos e inferenciales para comparar los dos períodos. Resultados: Un total de 355 estudiantes participaron en este estudio. Durante la pandemia, se observaron aumentos significativos en los síntomas de depresión grave (15,1% versus 24,8%), ansiedad moderada (18,3% versus 29,4%) y estrés moderado (40,9% versus 53,8%) entre los participantes. Además, hubo una reducción significativa en la CV, especialmente en el ámbito de las relaciones sociales (65,2 versus 59,6, valor de p 0,029). Conclusión: Se evidenció un deterioro en tanto la calidad de vida como la salud mental de los estudiantes de salud durante la pandemia de COVID-19.

RESUMO Objetivo: Avaliar a qualidade de vida (QV) e a presença de sintomas de depressão, ansiedade e estresse em estudantes da área da saúde, em comparação ao período anterior à pandemia de COVID-19. Métodos: Pesquisa transversal comparativa em uma universidade pública brasileira. A QV foi avaliada por meio da escala WHOQOL-bref, enquanto os sintomas de depressão, ansiedade e estresse foram avaliados usando a escala DASS-21. Foram empregadas análises descritivas e inferenciais para comparar os dois períodos. Resultados: Um total de 355 estudantes participaram deste estudo. Durante a pandemia, foram observados aumentos significantes nos sintomas de depressão grave (15,1% versus 24,8%), ansiedade moderada (18,3% versus 29,4%) e estresse moderado (40,9% versus 53,8%) entre os participantes. Além disso, houve uma redução significativa na QV, especialmente no domínio das relações sociais (65,2 versus 59,6, p-valor 0,029). Conclusão: Evidenciou-se piora da QV e da saúde mental dos estudantes da saúde durante a pandemia de COVID-19.

Resumo A Doença de Chagas (DC) é reconhecida pela Organização Mundial da Saúde como uma das treze doenças tropicais mais negligenciadas do mundo. A autopercepção de saúde é considerada um melhor preditor de mortalidade do que medidas objetivas do estado de saúde, e o contexto em que se vive influencia esse preditor. O objetivo deste estudo foi avaliar a prevalência e os fatores individuais e contextuais associados à pior autopercepção em saúde de pacientes com DC de uma região endêmica do Brasil. É um estudo transversal multinível. Os dados individuais vêm de um corte transversal de um estudo de coorte denominado SaMi-Trop. Os dados contextuais foram coletados a partir de plataformas e sistemas de informações institucionais acessíveis ao público. A variável dependente foi a autopercepção de saúde. A análise foi realizada por meio de regressão logística binária multinível. Participaram do estudo 1.513 pacientes com DC, sendo 335 (22,1%) com pior autopercepção de saúde. Este estudo revelou a influência da organização/oferta do serviço público de saúde brasileiro e de características individuais na autopercepção de saúde de pacientes com DC.

Abstract Chagas disease (CD) is recognized by the World Health Organization as one of the thirteen most neglected tropical diseases in the world. Self-perceived health is considered a better predictor of mortality than objective measures of health status, and the context in which one lives influences this predictor. This study aimed to evaluate the prevalence and individual and contextual factors associated with poor self-rated health among CD patients from an endemic region in Brazil. It is a multilevel cross-sectional study. The individual data come from a cross-section of a cohort study named SaMi-Trop. Contextual data was collected from publicly accessible institutional information systems and platforms. The dependent variable was self-perceived health. The analysis was performed using multilevel binary logistic regression. The study included 1,513 patients with CD, where 335 (22.1%) had Poor self-rated health. This study revealed the influence of the organization/offer of the Brazilian public health service and of individual characteristics on the self-perceived health of patients with CD.

Resumo A Doença de Chagas (DC) é reconhecida pela Organização Mundial da Saúde como uma das treze doenças tropicais mais negligenciadas do mundo. A autopercepção de saúde é considerada um melhor preditor de mortalidade do que medidas objetivas do estado de saúde, e o contexto em que se vive influencia esse preditor. O objetivo deste estudo foi avaliar a prevalência e os fatores individuais e contextuais associados à pior autopercepção em saúde de pacientes com DC de uma região endêmica do Brasil. É um estudo transversal multinível. Os dados individuais vêm de um corte transversal de um estudo de coorte denominado SaMi-Trop. Os dados contextuais foram coletados a partir de plataformas e sistemas de informações institucionais acessíveis ao público. A variável dependente foi a autopercepção de saúde. A análise foi realizada por meio de regressão logística binária multinível. Participaram do estudo 1.513 pacientes com DC, sendo 335 (22,1%) com pior autopercepção de saúde. Este estudo revelou a influência da organização/oferta do serviço público de saúde brasileiro e de características individuais na autopercepção de saúde de pacientes com DC.

Abstract Chagas disease (CD) is recognized by the World Health Organization as one of the thirteen most neglected tropical diseases in the world. Self-perceived health is considered a better predictor of mortality than objective measures of health status, and the context in which one lives influences this predictor. This study aimed to evaluate the prevalence and individual and contextual factors associated with poor self-rated health among CD patients from an endemic region in Brazil. It is a multilevel cross-sectional study. The individual data come from a cross-section of a cohort study named SaMi-Trop. Contextual data was collected from publicly accessible institutional information systems and platforms. The dependent variable was self-perceived health. The analysis was performed using multilevel binary logistic regression. The study included 1,513 patients with CD, where 335 (22.1%) had Poor self-rated health. This study revealed the influence of the organization/offer of the Brazilian public health service and of individual characteristics on the self-perceived health of patients with CD.

Abstract The lack of resources to deal with challenging situations may hinder the student’s adjustment to the university and increase the risk of academic failure. With this in mind, this study aimed to verify whether there is a relationship between the profile, life habits, academic experiences, and resilience of undergraduate students in the areas of Health and Psychology. This is a cross-sectional and inferential study. A total of 361 undergraduate students of Biomedicine, Physical Education, Nursing, Pharmacy, Physical Therapy, Medicine, Nutrition, Occupational Therapy, and Psychology, registered in three Federal Institutions of Higher Education in the interior of Minas Gerais participated in the study. We used a sociodemographic and lifestyle questionnaire, the Resilience Scale, and the Questionnaire of Academic Experiences - short version, answered online by the undergraduates, and descriptive and correlational analyses. The results showed average resilience for most university students and good adaptation to the university context, as well as showing relationships between resilience and the study period, being in psychotherapy, positively evaluating their own health, and all dimensions of academic experiences. We conclude that resilience is an important capacity to face the demands of undergraduate courses and that developing it is possible, especially during the beginning of undergraduate life and by adopting interventions focused on self-knowledge, self-efficacy, and good coping strategies. Developing the resilience of students can contribute to promote health in this population and reduce dropout rates in higher education.

Resumen La falta de recursos para afrontar situaciones desafiantes puede dificultar la adaptación del estudiante a la universidad y aumentar el riesgo de fracaso académico. Con esto en mente, el objetivo de este estudio fue verificar si existe una relación entre el perfil, los hábitos de vida, las experiencias académicas y la resiliencia de los estudiantes de grado en las áreas de Salud y Psicología. Se trata de un estudio transversal e inferencial. Participaron 361 estudiantes de pregrado de Biomedicina, Educación Física, Enfermería, Farmacia, Fisioterapia, Medicina, Nutrición, Terapia Ocupacional y Psicología, matriculados en tres Instituciones Federales de Educación Superior del interior de Minas Gerais. Se utilizó un cuestionario sociodemográfico y de hábitos de vida, la Escala de Resiliencia y el Cuestionario de Vivencias Académicas - Versión Reducida, que los universitarios respondieron en línea, y se realizaron análisis descriptivos y correlativos. Los resultados mostraron una resiliencia media para la mayoría de los estudiantes universitarios y una buena adaptación al contexto universitario, además mostraron relaciones entre la resiliencia y el periodo estudiado, estar en psicoterapia, evaluar positivamente su propia salud y todas las dimensiones de las experiencias académicas. Concluimos que la resiliencia es una capacidad importante para afrontar las exigencias de la graduación y que es posible desarrollarla, especialmente durante el inicio de esta y con la adopción de intervenciones centradas en el autoconocimiento, la autoeficacia y las buenas estrategias de afrontamiento. Desarrollar la resiliencia de los estudiantes puede contribuir a promover la salud de esta población y a reducir el abandono escolar en la enseñanza superior.

Resumo A falta de recursos para lidar com situações desafiadoras pode dificultar o ajuste do estudante à universidade e aumentar o risco de fracasso acadêmico. Pensando nisso, o objetivo deste estudo foi verificar se há relação entre o perfil, os hábitos de vida, as vivências acadêmicas e a resiliência de graduandos das áreas da saúde e Psicologia. Trata-se de um estudo transversal e inferencial. Participaram 361 graduandos dos cursos de Biomedicina, Educação Física, Enfermagem, Farmácia, Fisioterapia, Medicina, Nutrição, Terapia Ocupacional e Psicologia, matriculados em três instituições federais de Ensino Superior do interior de Minas Gerais. Utilizou-se um questionário sociodemográfico e de hábitos de vida, a Escala de Resiliência e o Questionário de Vivências Acadêmicas - versão reduzida -, respondidos de forma on-line pelos universitários, bem como análises descritivas e correlacionais. Os resultados mostraram resiliência média para a maioria dos universitários e boa adaptação ao contexto universitário, além de relações entre a resiliência e o período cursado, estar em psicoterapia, avaliar positivamente a própria saúde e todas as dimensões das vivências acadêmicas. Conclui-se que a resiliência é uma capacidade importante para enfrentar as demandas da graduação e que é possível desenvolvê-la, especialmente durante o começo da graduação e com a adoção de intervenções focadas no autoconhecimento, na autoeficácia e em boas estratégias de enfrentamento. Desenvolver a resiliência nos estudantes pode colaborar para a promoção da saúde desta população e a redução da evasão no Ensino Superior.

ABSTRACT Currently, there are no biomarkers for Chikungunya fever (CHIK) in clinical practice that can accurately predict the severity or chronification of the disease. The aim of this study is to evaluate the existing literature on biomarkers related to the severity and chronification of CHIK. In this sense, a systematic review was conducted based on the PRISMA Statement guideline. Articles that described the association of biomarkers with the evolution of the disease (severity or chronification), published until August 20th 2019 were considered eligible. The search was carried out in the PubMed, Scopus, Virtual Health Library (VHL) and Science Direct databases. After searching the databases, 17 articles were added to the review, and after analyzing the articles, several biomarkers were associated with severity, such as increased levels of IL-6, IP-10, IL-1b, MIG, MCP-1, and reduced levels of RANTES and IL-8 or chronification, such as increased levels of IL-6, TNF-α, MCP-1, IL-12, INF-α, IL-13, INF-γ, GM-CSF, CRP, IL-1a, IL-15, Factor VII, IP-10, IL-10, IL-4, IL-1RA, IL-8, MIP-1α, MIP-1β, ferritin, MIG, ESR, NO, malondialdehyde, and reduced levels of RANTES, ferritin, eotaxin, HGF, IL-27, IL-17A, IL-29, TGF-β, IL-10, and thiols. IL-6, CRP and TNF-α were included in the meta-analysis to assess the relationship with chronification, although they did not reach statistical significance. It was concluded that several biomarkers showed a relationship with severity and chronification of CHIK; the search for these biomarkers can reveal prognostic factors and important therapeutic targets for the treatment of the disease.

ABSTRACT The SaMi-Trop project is a cohort study conducted in 21 municipalities of endemic areas of Chagas disease, including 1,959 patients with chronic Chagas cardiomyopathy. In this article we updated the results of the project, adding information from the second cohort visit. Trypanosoma cruzi-seropositive patients were enrolled from the primary care Telehealth service in Minas Gerais State, Brazil. The eligibility criterium for the second visit was the participation in the baseline evaluation. Of 1,959 participants at the baseline assessment, 1,585 (79.9%) returned after two years for the second evaluation. The mortality rate was 6.7%, but varied from 0.9% to 18.2% when it was stratified by certain clinical characteristics. A lower age-adjusted NT-Pro-BNP level (less than 300) and a prior benznidazole treatment were associated with lower mortality. There was an improvement in most quality of life domain scores. Participants have also reported fewer signs and symptoms and greater use of medication. The second follow-up visit will be complete in Oct 2021.

ABSTRACT Chagas disease (CD) is still a neglected disease. Infected individuals are diagnosed late, being treated in worse clinical conditions. Thus, this study aimed to analyze the prevalence and the factors associated with new confirmed cases of CD identified by serological screening in an endemic region of Minas Gerais State, Brazil. This is an analytical cross-sectional study with data from a project of the Research Center in Tropical Medicine of Sao Paulo- Minas Gerais (SaMi-Trop) conducted in two municipalities. Data collection included a questionnaire with closed questions, a venous blood collection and an ELISA serological test for CD. A total of 2,038 individuals with no previous diagnosis of CD participated in the study. The result of the serological test for CD was adopted as the dependent variable. The independent variables addressed personal issues, health conditions and lifetime housing. A descriptive analysis of individual variables was performed. Subsequently, a bivariate analysis was performed using the Pearson’s chi-square test. Households sheltering individuals positive for CD were georeferenced, and the analysis of spatial distribution was performed using the quartic function to estimate the density of the nucleus. Among the participants, 188 (9.2 %) were positive for CD. The profile of participants with CD was associated with place of residence, age, relative/family member with CD and living conditions. It is noteworthy that there are still patients with CD who are unaware of their diagnosis in both, rural and urban areas.

Resumo Introdução Este trabalho discute a possibilidade de utilização de informações sobre a vacinação infantil reportada pelas mães em inquéritos domiciliares para a construção de indicadores de cobertura vacinal no Brasil. Objetivo Avaliar o potencial das informações declaradas pelas mães sobre a imunização das crianças em inquéritos domiciliares como uma fonte para o cálculo do indicador de cobertura vacinal. Método Analisaram-se os indicadores de confiabilidade (precisão) e validade (concordância) entre as informações disponíveis nos cartões de vacina das crianças menores de 2 anos e as informações reportadas pelas mães em pesquisas domiciliares realizadas nos anos de 2013 e 2015 no município de Santo Antônio do Monte, Minas Gerais. Resultados O principal resultado mostra que, em um contexto de alta cobertura, as mães tendiam a informar sobre a vacinação de seus filhos de forma aleatória, ou seja, informações reportadas pelas mães apresentavam baixa validade. Conclusão Embora a coleta de informações dos cartões de vacina das crianças seja um procedimento mais custoso, essa é a forma mais adequada e confiável de se mensurar a cobertura vacinal no contexto brasileiro.

Abstract Background This study discusses the possibility of using information on child vaccination reported by mothers through household surveys to construct indicators of immunization coverage in Brazil. Objective Evaluate the potential of information reported by mothers on the immunization of children in household surveys as a source to calculate a vaccination coverage indicator. Method The indicators of reliability (accuracy) and validity (concordance) between the information available on the vaccination cards of children under two years of age and that reported by mothers in two household surveys conducted in 2013 and 2015 in the municipality of Santo Antônio do Monte, state of Minas Gerais, Brazil. Results The main result shows that, in a context of high coverage, the mothers tended to inform randomly about the vaccination of their children, that is, the information reported by mothers presented low validity. Conclusion Although collecting information from children's vaccination cards is a more costly procedure, it is the most adequate and reliable way to measure vaccination coverage in the Brazilian context.

ABSTRACT Chagas disease (CD) is a neglected tropical highly morbid disease that can have a negative impact on the quality of life (QoL). The purpose of this study was to conduct an integrative review to analyze the QoL of patients with CD in the chronic phase of the disease, as well as the instruments used and the effect of different interventions. The review was carried out based on the criteria and recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guideline (PRISMA) using the PubMed, Scopus, Web of Science and Science Direct databases. An analysis of the reference list of the included articles was also carried out. Publications in all languages have been included. Two independent reviewers selected the eligible articles and extracted the data. A total of 1,479 articles were identified, and after applying the inclusion criteria 18 articles were included. Four different instruments were used to assess QoL and the most used was the Minnesota Living with Heart Failure Questionnaire (MLWHFQ) [33.3% (n = 6)]. Investigations involving intervention showed a positive impact on the patients’ QoL, and the Environment domain had the lowest score. Heterogeneity of instruments and lack of methodology standardization for assessing QoL was observed. QoL proved to be an important indicator for the planning and monitoring of patients with CD, however it is suggested that the instruments for its assessment should be the ones recommended by the validation studies. This process will allow the comparison of data between investigations.

ABSTRACT BACKGROUND: Instant messaging services (IMS) are widely used in medical practice. OBJECTIVE: To evaluate perceptions regarding use and usability of IMS within clinical practice and assess users’ knowledge of the ethical and legal context involved in using IMS within medical practice. DESIGN AND SETTING: Cross-sectional study conducted in different hospitals and medical institutions in Minas Gerais, Brazil. METHODS: Medical students, medical residents, primary care physicians and specialist doctors answered an online questionnaire regarding epidemiological data, graduation level and use of IMS for medical communication. Responses were collected over a five-month period and data were assessed using the IBM-SPSS software. RESULTS: 484 people answered the questionnaire: 97.0% declared that they were using IMS for medical-related purposes; 42.0%, to elucidate medical concerns every week; 75.0%, to share imaging or laboratory tests and patients’ medical records; and 90.5%, to participate in clinical case-study private groups. Moreover, only 37.0% declared that they had knowledge of the legislative aspects of use of smartphones within clinical practice. Differences in the frequency of discussion of medical concerns within the daily routine between student/residents and general practitioners/specialists, and in the frequency of image-sharing and patient-guiding/assistance between students and medical doctors, were observed. CONCLUSIONS: Our results provide reliable proof that medical doctors and students use IMS, as a tool for clinical case discussions, interactions between healthcare providers and patients, or dissemination of knowledge and information. Nonetheless, because of limitations to the ethical and legal regulations, evidence-based discussions between authorities, academics and medical institutions are needed in order to fully achieve positive outcomes from such platforms.