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Patients’ perception on stressful events for fibromyalgia development Patients
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Oliveira, Ana Julia Campi Nunes de

; Di-Giovanni, Thaís

; Vanzelli, Cassiano Henrique Giovanini

; Araujo, Bruno de Mendonça Moraes

; Gianini, Reinaldo José

; Martinez, José Eduardo

BrJP

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2024, Volume 7 elocation e20240051

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO JUSTIFICATIVA E OBJETIVOS: A síndrome da fibromialgia (FM) é uma doença reumática com as seguintes características: dor crônica generalizada, fadiga, sono não restaurador e distúrbios cognitivos. Ela é frequentemente associada à angústia após exposições a estressores crônicos e agudos. O objetivo deste estudo foi determinar a percepção dos pacientes se os eventos estressantes influenciam o desenvolvimento da FM. O objetivo secundário foi avaliar o impacto do estresse agudo na determinação da gravidade futura da FM. MÉTODOS: Foram realizados um estudo transversal para o objetivo primário e um estudo de caso controle para o objetivo secundário. Foram utilizados questionários sobre dados demográficos e instrumentos de avaliação da gravidade e impacto da FM (Índice Fibromiálgico - FI, e Revised Fibromyalgia Impact Questionnarie - FIQr), instrumentos de avaliação de aspectos emocionais (PHQ-9 e GAD-7), e um questionário sobre a percepção dos pacientes em relação aos eventos estressores. RESULTADOS: Sessenta e um pacientes foram avaliados. Cerca de 59% relataram a presença de estresse agudo como um fator agravante. Os pacientes mencionaram o luto por um parente próximo, problemas financeiros, conflitos familiares e serem vítimas de violência como eventos agravantes. Houve associação significativa entre a presença de incidentes estressantes, FI e FIQr (p<0,05). A presença de circunstâncias agravantes aumentou o escore do FIQr em 2,72. CONCLUSÃO: Foi observada associação significativa entre eventos estressantes agravantes e pontuações mais altas do índice de FM e seu impacto sobre os pacientes. OBJETIVOS (FM características generalizada fadiga cognitivos agudos MÉTODOS Índice FIQr, , FIQr) PHQ9 PHQ 9 (PHQ- GAD7, GAD7 GAD 7 GAD-7) RESULTADOS avaliados 59 agravante próximo financeiros p<0,05. p005 p p<0,05 . 0 05 (p<0,05) 272 2 72 2,72 CONCLUSÃO (PHQ GAD-7 5 p00 p<0,0 (p<0,05 27 2,7 GAD- p0 p<0, (p<0,0 2, p<0 (p<0, p< (p<0 (p< (p

ABSTRACT BACKGROUND AND OBJECTIVES: Fibromyalgia syndrome (FM) is a rheumatic disease with the following characteristics: generalized chronic pain, fatigue, non-restorative sleep and cognitive disturbances. It is often associated to distress followed chronic and acute stressors exposures. The objective of this study was to determine the patients’ perception if stressful events influence the development of FM. The secondary objective was to evaluate the impact of acute stress in determining the future severity of FM. METHODS: A cross-sectional study was carried out for the primary objective and a case-control study for the secondary objective. We used questionnaires on demographic data and instruments for assessing the severity and impact of FM (Fibromyalgia Index - FI, and Revised Fibromyalgia Impact Questionnaire - FIQr), instruments for assessing emotional aspects (PHQ-9 and GAD-7), and a questionnaire on patients’ perception of stressful events. RESULTS: Sixty-one patients were evaluated. About 59% reported the presence of acute stress as an aggravating factor. Patients mentioned grief for a close relative, financial problems, family conflicts, and being a victim of violence as aggravating events. There was a significant association between the presence of stressful incidents, FI and FIQr (p<0.05). The presence of aggravating circumstances increased the FIQr score by 2.72. CONCLUSION: It was observed a significant association between aggravating stressful events and higher index FM scores and their impact on the patients. OBJECTIVES (FM characteristics pain fatigue nonrestorative non restorative disturbances exposures METHODS crosssectional cross sectional casecontrol case control FIQr, , FIQr) PHQ9 PHQ 9 (PHQ- GAD7, GAD7 GAD 7 GAD-7) RESULTS Sixtyone Sixty one evaluated 59 factor relative problems conflicts incidents p<0.05. p005 p p<0.05 . 0 05 (p<0.05) 272 2 72 2.72 CONCLUSION (PHQ GAD-7 5 p00 p<0.0 (p<0.05 27 2.7 GAD- p0 p<0. (p<0.0 2. p<0 (p<0. p< (p<0 (p< (p

https://doi.org/10.5935/2595-0118.20240051-en

Is the symptom of pain adequately addressed in hospitalization at Internal Medicine? Cross-sectional study Medicine Crosssectional Cross sectional
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Martinez, José Eduardo

; Moises, Thamires Guedes Leite

; Cabo, Júlia Santos do

BrJP

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jul 2023, Volume 6 N. 3 Pages 263 - 268

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO JUSTIFICATIVA E OBJETIVOS: Dor é um dos principais motivos por assistência ao serviço médico-hospitalar. Desta forma, o objetivo deste estudo foi avaliar o atendimento de queixas dolorosas em enfermaria de clínica médica. MÉTODOS: Estudo transversal e descritivo nos hospitais Santa Lucinda (HSL) e Conjunto Hospitalar de Sorocaba (CHS). A coleta de dados foi realizada por: (1) entrevista com os participantes direcionada por um questionário estruturado elaborado pelos pesquisadores, e (2) acesso a informações como registro de dor e prescrição de fármacos no prontuário. RESULTADOS: A amostra foi composta por 85 pacientes, sendo 11.8% no HSL e 88,2% no CHS. Mais de 80% dos participantes relataram experiência prévia de dor aguda ou crônica em algum momento da vida. Quarenta e um por cento dos participantes relatou dor durante a internação independente da causa da internação. A minoria dos eventos de dor constava nos registros da queixa em seu prontuário. Houve fármaco prescrito para 73% dos pacientes, sendo em sua maioria, por demanda. Houve uma inadequação entre o tipo de fármaco prescrito e a intensidade da dor em 80% das prescrições. CONCLUSÃO: A queixa de dor é um sintoma prevalente entre pacientes internados de Clínica Médica. Neste estudo, 41,2%; das dores foram musculoesqueléticas, seguida de dores abdominais, independente do motivo da internação. A queixa de dor foi medicada na maior parte dos relatos de dor dos pacientes, porém cerca de 23% dos pacientes com queixa de dor não receberam fármacos. A maior parte dos pacientes (80%) com dor recebeu fármacos incoerentes à intensidade da dor; porém o registro da queixa de dor nas evoluções dos prontuários permanece insuficiente. OBJETIVOS médicohospitalar. médicohospitalar médico hospitalar. hospitalar médico-hospitalar forma médica MÉTODOS (HSL CHS . (CHS) 1 (1 pesquisadores 2 (2 prontuário RESULTADOS 8 118 11 11.8 882 88 88,2 80 vida 73 maioria demanda prescrições CONCLUSÃO Médica 41,2% 412 41 musculoesqueléticas abdominais 23 (80% insuficiente (CHS ( 11. 88, 7 41,2 4 (80 41, (8

ABSTRACT BACKGROUND AND OBJECTIVES: Pain is one of the main reasons for seeking medical care. Thus, the objective of the present study was to evaluate the treatment of pain complaints in a medical clinic ward. METHODS: Cross-sectional and descriptive study at the Santa Lucinda Hospital (Hospital Santa Lucinda - HSL) and Sorocaba Hospital Complex (Conjunto Hospitalar de Sorocaba - CHS). Data was collected by: (1) interviewing the participants using a structured questionnaire drawn up by the researchers, and (2) accessing information such as pain records and drug prescriptions in the medical records. RESULTS: The sample consisted of 85 patients, 11.8% in the HSL and 88.2% in the CHS. More than 80% of patients had already experienced pain at some point in their lives, whether chronic or acute. Forty-one percent of patients had pain during hospitalization, regardless of the reason for admission. A minority of pain events had the complaint recorded in their medical records. Drugs were prescribed for 73.0% of the patients, mostly on demand. There was a mismatch between the type of drug prescribed and the intensity of the pain in 80% of prescriptions. CONCLUSION: The complaint of pain is prevalent in Internal Medicine hospitalizations. In this study, 41.2% of the pain was musculoskeletal, followed by abdominal pain, regardless of the reason for hospitalization. The complaint of pain was medicated in most of the patients’ pain reports, but around 23% of the patients complaining of pain did not receive drugs. Most patients (80%) with pain received drugs that were inconsistent with the intensity of the pain; however, the recording of the complaint of pain in the medical records remains insufficient. OBJECTIVES care Thus ward METHODS Crosssectional Cross sectional Conjunto CHS . CHS) 1 (1 researchers 2 (2 RESULTS 8 118 11 11.8 882 88 88.2 80 lives acute Fortyone Forty hospitalization admission 730 73 0 73.0 demand CONCLUSION hospitalizations 412 41 41.2 musculoskeletal reports 23 (80% however insufficient ( 11. 88. 7 73. 4 41. (80 (8

https://doi.org/10.5935/2595-0118.20230072-en

Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force
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Tavares, Anna Carolina Faria Moreira Gomes

; Melo, Ana Karla Guedes de

; Cruz, Vítor Alves

; Souza, Viviane Angelina de

; Carvalho, Joana Starling de

; Machado, Ketty Lysie Libardi Lira

; Valadares, Lilian David de Azevedo

; Reis Neto, Edgard Torres dos

; Rezende, Rodrigo Poubel Vieira de

; Guimarães, Maria Fernanda Brandão de Resende

; Ferreira, Gilda Aparecida

; Braz, Alessandra de Sousa

; Vieira, Rejane Maria Rodrigues de Abreu

; Pinheiro, Marcelo de Medeiros

; Ribeiro, Sandra Lúcia Euzébio

; Bica, Blanca Elena Gomes Rios

; Baptista, Kátia Lino

; Costa, Izaias Pereira da

; Marques, Claudia Diniz Lopes

; Lopes, Maria Lúcia Lemos

; Martinez, José Eduardo

; Giorgi, Rina Dalva Neubarth

; Mota, Lícia Maria Henrique da

; Loures, Marcos Antônio Araújo da Rocha

; Paiva, Eduardo dos Santos

; Monticielo, Odirlei André

; Xavier, Ricardo Machado

; Kakehasi, Adriana Maria

; Pileggi, Gecilmara Cristina Salviato

Advances in Rheumatology

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2022, Volume 62 elocation 3

Abstract: En | Text: En | PDF: En

Abstract Objective: To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. Methods: A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle–Ottawa Scale to assess the quality of nonrandomized studies. Results: All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4—agree—and 5—strongly agree—, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. Conclusion: These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.

https://doi.org/10.1186/s42358-022-00234-7

Screening for cognitive impairment among individuals aged 60 years or over: scoping review
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Feichtenberger, Patrícia Regina Piedade

; Rocha, Maura Regina Laureano

; dos Santos Puga, Maria Eduarda

; Martinez, José Eduardo

Sao Paulo Medical Journal

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may 2021, Volume 139 N. 5 Pages 520 - 534

Abstract: En | Text: En | PDF: En

BACKGROUND: Growth in aging of the population has led to increasing numbers of elderly people presenting cognitive impairment and evolution to dementia. There is still no consensus within primary care on the best strategy for screening for cognitive impairment among elderly people. Standardization of a simple but reasonably accurate instrument for a brief cognitive test, in primary care environments, would enable healthcare professionals to identify individuals who require a more in-depth assessment of cognition. OBJECTIVES: To investigate the instruments used by healthcare professionals in studies conducted worldwide and ascertain the most suitable instruments for screening for cognitive impairment among individuals aged 60 years or over, in the Brazilian population. DESIGN AND SETTING: Scoping review developed at Pontifícia Universidade Católica de São Paulo, Brazil. METHOD: A systematic search of the literature was conducted for primary studies using instruments to screen for cognitive impairment among individuals aged 60 years or over, in the MEDLINE, EMBASE, Cochrane Central and LILACS databases. RESULTS: A total of 983 articles were identified by two independent reviewers, from which 49 were selected for full-text reading, based on the criteria defined for this review. From this, 16 articles adhering to the theme of screening for cognitive impairment among the elderly were selected for in-depth analysis. CONCLUSION: The Mini-Mental State Examination was the instrument most cited in these studies. The Pfeffer Functional Activities Questionnaire and the Verbal Fluency Test (semantic category) present characteristics favoring further studies, for testing as screening instruments for cognitive impairment among elderly people in Brazil.

https://doi.org/10.1590/1516-3180.2020.0635.150321 6 downloads

Treatment data from the Brazilian fibromyalgia registry (EpiFibro)
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Assis, Marcos Renato de

; Paiva, Eduardo dos Santos

; Helfenstein Jr, Milton

; Heymann, Roberto Ezequiel

; Pollak, Daniel Feldman

; Provenza, Jose Roberto

; Ranzolin, Aline

; Rezende, Marcelo Cruz

; Ribeiro, Luiz Severiano

; Souza, Eduardo José R.

; Martinez, José Eduardo

Advances in Rheumatology

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2020, Volume 60 elocation 09

Abstract: En | Text: En | PDF: En

Abstract Background: EpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study patients with fibromyalgia (FM). Patients were included since 2011 according to the classification criteria for FM of the American College of Rheumatology of 1990 (ACR1990). Objective: To analyze the therapeutic measures prescribed by Brazilian physicians. Materials and methods: Cross-sectional study of a multicenter cohort. The therapeutic measures were described using descriptive statistics. Results: We analyzed 456 patients who had complete data in the registry. The mean age was 54.0 ± 11.9 years; 448 were women (98.2%). Almost all patients (98.4%) used medications, 62.7% received health education, and less than half reported practicing physical exercise; these modalities were often used in combination. Most patients who practiced exercises practiced aerobic exercise only, and a significant portion of patients combined it with flexibility exercises. The most commonly used medication was amitriptyline, followed by cyclobenzaprine, and a minority used medication specifically approved for FM, such as duloxetine and pregabalin, either alone or in combination. Combinations of two or three medications were observed, with the combination of fluoxetine and amitriptyline being the most frequent (18.8%). Conclusion: In this evaluation of the care of patients with FM in Brazil, it was found that the majority of patients are treated with a combination of pharmacological measures. Non-pharmacological methods are underused, with aerobic exercise being the most commonly practiced exercise type. The most commonly prescribed single drug was amitriptyline, and the most commonly prescribed combination was fluoxetine and amitriptyline. Drugs specifically approved for FM are seldom prescribed.

https://doi.org/10.1186/s42358-019-0108-2 665 downloads

EpiFibro (Brazilian Fibromyalgia Registry): data on the ACR classification and diagnostic preliminary criteria fulfillment and the follow-up evaluation
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Martinez, José Eduardo

; Paiva, Eduardo S.

; Rezende, Marcelo C.

; Heymann, Roberto E.

; Helfenstein Jr., Milton

; Ranzolin, Aline

; Provenza, Jose Roberto

; Ribeiro, Luiz Severiano

; Souza, Eduardo J.R.

; Feldman, Daniel P.

; Assis, Marcos Renato de

Revista Brasileira de Reumatologia

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apr 2017, Volume 57 N. 2 Pages 129 - 133

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Introdução: O EpiFibro (Estudo Epidemiológico Brasileiro de Fibromialgia) foi criado para estudar pacientes com fibromialgia. Foram incluídos pacientes desde 2011 de acordo com os critérios de classificação para a fibromialgia do American College of Rheumatology de 1990 (ACR1990). Objetivos: Determinar quantos pacientes ainda atendem aos critérios ACR1990 e ACR2010 em 2014; determinar a correlação entre o impacto da FM medido pelo Questionário de Impacto da Fibromialgia (FIQ) e pela Polysymptomatic Distress Scale (PDS) e descrever dados sobre a avaliação de seguimento. Métodos: Estudo transversal em uma coorte multicêntrica de pacientes. Os dados foram coletados entre 2013 e 2015. O médico incluiu pacientes que atenderam aos critérios ACR1990 no momento da entrada. Consideraram-se os dados de seguimento apenas dos pacientes com pelo menos duas avaliações. Uma variação de 30% nos escores dos parâmetros foi considerada uma alteração minimamente significativa. Resultados: Analisaram-se os dados de 810 pacientes. Os pacientes apresentaram média de 51,8 ± 11,5 anos. Havia 786 mulheres. A maior parte dos pacientes atendeu a ambos os critérios. Houve um maior atendimento aos critérios ACR2010. Houve uma correlação moderada entre a PDS e o FIQ. Encontraram-se 314 pacientes com mais de uma avaliação, mas 88 pacientes foram excluídos. Assim, foram considerados 226 pacientes com um parâmetro de monitoramento no seguimento. (FIQ: 222; PDS: 199; ambos: 195). O tempo médio de seguimento foi de 9,1 ± 7,5 meses (1 a 44). A maior parte dos pacientes tornou-se estável. Conclusão: No EpiFibro, a maior parte dos pacientes atendia simultaneamente ao ACR1990 e ao ACR2010. Uma maior quantidade de pacientes atendia ao ACR2010 no momento da avaliação. Houve uma correlação moderada. A maior parte dos pacientes manteve-se estável ao longo do tempo.

Abstract Introduction: EpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study Fibromyalgia patients. Patients were included since 2011 according to the 1990 American College of Rheumatology Classification Criteria for Fibromyalgia (ACR1990). Objectives: To determine how many patients still fulfill the ACR1990 and the ACR2010 criteria in 2014; to determine the correlation between the impact of FM and to describe data on the follow-up evaluation. Methods: This is a cross sectional study in a multicenter cohort of patients. The data was collected between 2013 and 2015. Physician included patients that fulfilled the ACR1990 criteria on the date of entry. The follow-up data were considered only for patients with at least two evaluations. A minimally significant change was considered to be a 30% variation of parameters scores. Results: 810 patients’ data were analyzed. Patients presented a mean age of 51.8 ± 11.5 years old. There were 786 female. Most patients met both criteria. There was a greater fulfilling of the ACR2010. There was a moderate correlation between Polysymptomatic Distress Scale and Fibromyalgia Impact Questionnaire. Three hundred fourteen patients with more than one assessment were found, but 88 patients were excluded. Thus, 226 patients with one follow-up monitoring parameter were considered (Fibromyalgia Impact Questionnaire: 222; Polysymptomatic Distress Scale: 199; both: 195). The mean follow-up time was 9.1 ± 7.5 months (1–44). Most patients became stable. Conclusion: InEpiFibro, most patients fulfill simultaneously the ACR1990 and ACR2010. A larger number of patients fulfill the ACR2010 at the time of the evaluation. There was a moderate correlation between the Polysymptomatic Distress Scale and the Fibromyalgia Impact Questionnaire. Most patients remained stable over time.

https://doi.org/10.1016/j.rbre.2016.09.012 8286 downloads

New guidelines for the diagnosis of fibromyalgia
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Heymann, Roberto E.

; Paiva, Eduardo S.

; Martinez, José Eduardo

; Helfenstein Jr., Milton

; Rezende, Marcelo C.

; Provenza, Jose Roberto

; Ranzolin, Aline

; Assis, Marcos Renato de

; Feldman, Daniel P.

; Ribeiro, Luiz Severiano

; Souza, Eduardo J.R.

Revista Brasileira de Reumatologia

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2017, Volume 57 Suppl. 2 Pages s467 - s476

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo Estabelecer diretrizes baseadas em evidências científicas para o diagnóstico da fibromialgia. Material e métodos A coleta de evidências foi elaborada a partir de nove questões sobre diagnóstico da fibromialgia, estruturadas por meio do PICO (Paciente, Intervenção ou Indicador, Comparação e Outcome), com busca nas principais bases primárias de informação científica. Após definir os estudos potenciais para sustentação das recomendações, esses foram graduados pela força da evidência e grau de recomendação. Resultados e conclusões As questões resultaram em nove recomendações para o diagnóstico da fibromialgia com base nas evidências de literatura e na opinião dos experts que participaram do trabalho.

Abstract Objective To establish guidelines based on scientific evidence for the diagnosis of fibromyalgia. Material and methods Evidence collection was performed based on 9 questions regarding the diagnosis of fibromyalgia, structured using the Patient, Intervention or Indicator, Comparison and Outcome (P.I.C.O.), with searches in the main, primary databases of scientific information. After defining the potential studies to support the recommendations, they were graded according to evidence and degree of recommendation.

https://doi.org/10.1016/j.rbre.2017.07.002 96030 downloads

Análise das condições para diagnóstico de doenças reumáticas na atenção básica de saúde na cidade de Sorocaba-SP
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Chiereghin, Adriano

; Martinez, José Eduardo

Revista Brasileira de Reumatologia

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jun 2015, Volume 55 N. 3 Pages 251 - 255

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Objetivos: Definir o perfil do profissional que atende no setor primário de saúde na cidade de Sorocaba, analisar o meio em que está inserido e tentar identificar se há condições para o atendimento de doenças reumáticas de baixa complexidade e os possíveis motivos que levariam a um alto grau de encaminhamento aos especialistas. Métodos: Fizemos um estudo quantitativo no qual médicos da atenção básica de saúde foram convidados a responder um questionário que abordava aspectos pessoais do profissional, além de técnicos de quatro doenças reumáticas: osteoartrite, gota, fibromialgia e osteoporose, as quais serviram de base para avaliar o atendimento a doenças de baixa complexidade nas unidades básicas de saúde (UBS). Resultados: Observou-se que o profissional encontra-se inserido num sistema organizacional que dificulta sua atuação; além disso, perceberam-se certas dificuldades pessoais técnicas. Essas condições somadas acabam por ser fatores que determinam uma qualidade de atendimento aquém da esperada. Conclusão: É necessário que haja uma revisão de como a educação médica se dá, a fim de buscar uma formação mais qualificada e voltada para as necessidades básicas do sistema de saúde, além de uma reestruturação de todo sistema de saúde do ponto de vista de organização e gestão, para que haja uma condição adequada para o desenvolvimento de uma boa prática médica e, consequentemente, uma boa prestação de serviço à população.

Objectives: The study had as main goal to define the profile of the attending professional working at the primary healthcare sector in the city of Sorocaba, and to analyze the environment in which this professional is inserted, trying to identify if there are conditions for the care of low-complexity rheumatic diseases and possible reasons that would lead to a high degree of referral to specialists. Methods: A quantitative study was performed in which physicians of primary health care were invited to answer a questionnaire that addressed personal aspects, besides the technical aspects of four rheumatic diseases: osteoarthritis, gout, fibromyalgia and osteoporosis, which served as the basis for evaluating the care for low-complexity diseases in UBSs. Results: It was observed that the professional is part integral of an organizational system that hinders his/her performance; moreover, certain personal difficulty techniques were realized. Together, these conditions turned out to be the factors that determine a quality of care that falls short of that expected. Conclusion: There must be a review of how medical education is offered, in order to seek a more qualified training, focused on the basic needs of the health system, as well as a restructuring of the entire health system in terms of its organization and management, in order to attain a suitable condition for the development of a good medical practice, and thus, for providing a good service to the community.

https://doi.org/10.1016/j.rbr.2014.04.008 3252 downloads

A associação fibromialgia e lúpus eritematoso sistêmico altera a apresentação e a gravidade de ambas as doenças?
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Araújo, Ana Luiza P. Kasemodel de

; Paliares, Isabella Cristina

; Araújo, Maria Izabel P. Kasemodel de

; Novo, Neil Ferreira

; Cadaval, Ricardo Augusto M.

; Martinez, José Eduardo

Revista Brasileira de Reumatologia

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feb 2015, Volume 55 N. 1 Pages 37 - 42

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Introdução A associação da fibromialgia (FM) e de lúpus eritematoso sistêmico (LES) tem sido investigada com resultados conflitantes em relação ao impacto de uma condição na outra. Objetivos Determinar a frequência de FM em uma amostra de pacientes com LES atendidos no Conjunto Hospitalar de Sorocaba (CHS) e o impacto da FM na atividade do LES e na qualidade de vida, bem como do LES na FM. Material e métodos Estudo descritivo e transversal. Incluíram-se pacientes que preenchem os critérios de classificação para LES e/ou de FM do Colégio Americano de Reumatologia (ACR). A amostra total foi dividida em três grupos: FM/LES (pacientes com associação LES e FM), LES (somente pacientes com LES) e FM (somente pacientes com FM). As seguintes variáveis foram Questionário de Impacto da Fibromialgia (FIQ), Índice de Atividade do Lúpus Eritematoso Sistêmico (Sledai), Índices dos Critérios Diagnósticos de Fibromialgia de 2010 (IGS E IDG) e o SF-36. Resultados A prevalência de pacientes com FM entre os pacientes com LES foi de 12%. O FIQ não apontou diferença entre os grupos e indicou que o LES não interferiu no impacto causado pela FM isoladamente. A presença da FM em pacientes com LES não influenciou a atividade clínica dessa doença. Observou-se um forte impacto da FM na qualidade de vida nos pacientes com LES e não foi observado o contrário. Conclusões A prevalência de FM observada nos pacientes com LES é de 12%. A presença de FM afeta adversamente a qualidade de vida dos pacientes com LES.

Introduction The association of fibromyalgia (FM) and systemic lupus erythematosus (SLE) has been investigated, with conflicting results regarding the impact of a condition on the other. Objectives To determine the frequency of FM in a sample of patients with SLE treated at the Hospital Complex of Sorocaba (CHS) and the impact of FM in SLE activity and quality of life, as well as of SLE in FM. Materials and Methods Descriptive and correlational study. Patients who met the American College of Rheumatology (ACR) criteria for SLE and/or FM were included. The total sample was divided into three groups: FM/SLE (patients with association of SLE and FM), SLE (SLE patients only) and FM (FM patients only). The following variables were used: Fibromyalgia Impact Questionnaire (FIQ), activity index of SLE (SLEDAI), Indices of Diagnostic Criteria for Fibromyalgia 2010 (SSI end GPI) and SF-36. Results The prevalence of patients with FM among SLE patients was 12%. FIQ showed no difference between groups, indicating that SLE did not affect the impact caused by FM alone. The presence of FM in SLE patients did not influence the clinical activity of this disease. A strong impact of FM on the quality of life in patients with SLE was observed; the opposite was not observed. Conclusions The prevalence of FM observed in SLE patients is 12%. The presence of FM adversely affects the quality of life of patients with SLE.

https://doi.org/10.1016/j.rbr.2014.08.004 7533 downloads

10.

Fibromyalgia and the old dilemma: theory vs. practice
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Martinez, José Eduardo

Psychology & Neuroscience

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jun 2014, Volume 7 N. 1 Pages 09 - 14

Abstract: En | Text: En | PDF: En

The objective of this article is to review some aspects of the fibromyalgia syndrome and its mechanisms of development. We also discuss how to go from preclinical research to clinical practice. Fibromyalgia is a clinical syndrome whose main features include diffuse musculoskeletal pain, fatigue, sleep disturbances, and cognitive disorders. Russell & Larsson (2009) proposed "pronociceptive" and "antinociceptive" systems under normal conditions. Functional pain states such as fibromyalgia are derived from central disturbances in pain processing. The association with anxiety and depression is a negative prognostic factor. Distress is an important part of its physiopathology. The concomitance of other functional syndromes is a rule. The already known etiopathogenic mechanisms of fibromyalgia can be applied in clinical practice for diagnosis and rational therapeutic approaches. Pharmacological but mainly nonpharmacological measures must be applied. Although much information still needs to be obtained, the clinician presently has sufficient tools for efficiently treating fibromyalgia patients. An important aspect is that such knowledge needs to reach primary care physicians because the prevalence of fibromyalgia does not allow all patients to be treated by specialists.

https://doi.org/10.3922/j.psns.2014.1.03 1737 downloads

11.

Estudo da automedicação para dor musculoesquelética entre estudantes dos cursos de enfermagem e medicina da Pontifícia Universidade Católica - São Paulo
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Martinez, José Eduardo

; Pereira, Giovanni Augusto Farina

; Ribeiro, Luiz Gustavo Martinelli

; Nunes, Ricardo

; Ilias, Daniel

; Navarro, Luiz Gustavo Moretti

Revista Brasileira de Reumatologia

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apr 2014, Volume 54 N. 2 Pages 90 - 94

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Objetivo: Estudar a automedicação para dor entre estudantes de cursos de medicina e enfermagem da PUCSP em comparação com estudantes das outras áreas de conhecimento.Material e métodos: Esses dados foram obtidos em dois grupos: A - estudantes da área da saúde e B - estudantes da área de ciências humanas e exatas. Utilizou-se um questionário elaborado pelos autores. A análise estatística usou o teste do qui-quadrado e de Fischer.Resultados: Na área de saúde há um predomínio do gênero feminino, e nas outras áreas um predomínio masculino. Na área de saúde a maior parte dos estudantes cursa medicina, e nas outras áreas engenharia. Observa-se um alto índice de automedicação em ambos os grupos, constatando-se que os participantes do grupo da área de saúde usam significativamente mais opioides e anti-inflamatórios que os demais estudados.Conclusão:A frequência do uso de medicamentos para dor é maior no grupo de estudantes da área de saúde, e a automedicação é praticada igualmente entre estudantes da área de saúde e das demais áreas.

Objective:To study the self-medication for pain among students of medicine and nursing of the PUCSP compared with students from other knowledge areas.Material and methods:Data were obtained in two groups: A - students from the health knowledge area, and B - students of law and engineering. It was used a questionnaire developed by the authors. Statistical analysis used the Chi-square test and the Fischer.Results:In relation to gender, there is a predominance of women in the health group and a male majority in other one. In the health group there was a greater number of medical students, and in the control group of engineering. It is observed a high degree of selftreatment in both groups. It appears that participants in the health group have used more anti-inflammatory drugs and opioid than the others subjects studied.Conclusion:The frequency of medication for pain is higher in the group of health students, and self-medication is equally practiced among students of health and other areas.

https://doi.org/10.1016/j.rbr.2014.03.002 6209 downloads Cited 1 time in SciELO

12.

Correlação entre variáveis demográficas e clínicas, e a gravidade da fibromialgia
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Martinez, José Eduardo

; Casagrande, Pâmela de Melo

; Ferreira, Paula Pratti Rodrigues

; Rossatto, Bruno Luigi Giaccio

Revista Brasileira de Reumatologia

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dec 2013, Volume 53 N. 6 Pages 460 - 463

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: A fibromialgia (FM) é uma condição reumatológica que se caracteriza por um quadro de dor crônica generalizada, hiperalgesia e alodinia. Podem estar presentes sintomas como fadiga, distúrbios do sono, rigidez matinal, cefaleia e parestesias. Também está associada a outras comorbidades, como depressão, ansiedade, síndrome do intestino irritável, síndrome miofascial e síndrome uretral inespecífica. Poucos trabalhos têm abordado a evolução da FM, em especial em relação a médio e longo prazo. Por que alguns pacientes se saem melhor do que outros, apesar de serem submetidos ao mesmo tratamento? OBJETIVO: Determinar se há correlação entre variáveis demográficas e clínicas, e a gravidade da FM. MATERIAL E MÉTODOS: Sessenta mulheres que preencheram os critérios de classificação para FM do American College of Rheumatology de 1990 foram divididas em três grupos, de acordo com a gravidade estabelecida pelo Questionário de Impacto da Fibromialgia (FIQ): severa (70-100); moderada (50-70) e leve (0-50). RESULTADOS: Foram analisadas nove variáveis demográficas e clínicas, sendo observada diferença significativa (P < 0,05) apenas nos grupos de maiores escores do FIQ, com a presença de depressão e interesses trabalhistas. CONCLUSÃO: O impacto da FM medido pelo FIQ se correlaciona diretamente com a intensidade da depressão e a presença de interesses trabalhistas.

INTRODUCTION: Fibromyalgia (FM) is a rheumatic condition characterized by a picture of generalized chronic pain, hyperalgesia and allodynia. Symptoms such as fatigue, sleep disorders, morning stiffness, headache and paresthesia can also be present. It is also associated with other comorbidities, such as depression, anxiety, irritable bowel syndrome, myofascial pain syndrome and nonspecific urethral syndrome. Few studies have addressed the evolution of FM, especially regarding medium and long-term evolution, such as why some patients do better than others, despite the fact of being submitted to the same treatment. OBJECTIVE: To determine whether there is a correlation between demographic and clinical variables and FM severity. MATERIAL AND METHODS: Sixty women who met the classification criteria for FM of the American College of Rheumatology of 1990 were divided into three groups, according to the severity established by the Fibromyalgia Impact Questionnaire (FIQ): severe (70-100), moderate (50 to 70) and mild (0 to 50). RESULTS: Nine demographic and clinical variables were assessed, with a significant difference (P <0.05) being observed only in the groups showing higher FIQ scores with the presence of depression and workers' compensation interests. Conclusion: The impact of FM measured by the FIQ is directly correlated with the severity of depression and the presence of workers' compensation interests.

https://doi.org/10.1016/j.rbr.2013.04.002 5382 downloads

13.

Qualidade de Vida de pacientes submetidos à revascularização do miocárdio
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Dal Boni, Andréia Lima Matos

; Martinez, José Eduardo

; Saccomann, Izabel Cristina Ribeiro da Silva

Acta Paulista de Enfermagem

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dec 2013, Volume 26 N. 6 Pages 575 - 580

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Determinar o impacto da cirurgia de revascularização do miocárdio na Qualidade de Vida dos pacientes; analisar e comparar dimensões da Qualidade de Vida antes e após a intervenção cirúrgica; comparar variáveis sociodemográficas e clínicas aos aspectos de depressão e ansiedade, pré e pós-operatórios. MÉTODOS: Estudo descritivo exploratório no qual foram incluídos 78 pacientes no pré e pós-operatório. Foram utilizados instrumentos de pesquisa internacionais e validados para avaliar a qualidade de vida e os aspectos de depressão e ansiedade. RESULTADOS: Houve melhora significativa em todos os domínios da Qualidade de Vida, depressão e ansiedade (p=0,05). Domínios físico e social do 36-Item Short-Form Health Survey apresentaram menor pontuação dos escores (13,46 e 3,03, respectivamente), bem como o domínio social do instrumento Macnew (3,03). CONCLUSÃO: Cirurgia de revascularização ocasionou impacto positivo na Qualidade de Vida desses pacientes.

OBJECTIVE: Determining the impact of coronary artery bypass grafting on the Quality of Life of patients, analyzing and comparing dimensions of Quality of Life before and after surgery; comparing sociodemographic and clinical variables with the aspects of depression and anxiety, in the pre and postoperative periods. METHODS: A descriptive exploratory study in which 78 patients were included in the pre and postoperative periods. International instruments of research were used and validated to assess quality of life and the aspects of depression and anxiety. RESULTS: There was significant improvement in all domains of the Quality of Life, depression and anxiety (p=0.05). The physical and social domains of the 36-Item Short-Form Health Survey showed lower scores (13.46 and 3.03, respectively), as well as the social domain of the Macnew instrument (3.03). CONCLUSION: Coronary artery bypass surgery caused positive impact on the Quality of Life of these patients.

6553 downloads

14.

Qualidade de Vida de pacientes submetidos à revascularização do miocárdio
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Dal Boni, Andréia Lima Matos

; Martinez, José Eduardo

; Saccomann, Izabel Cristina Ribeiro da Silva

Acta Paulista de Enfermagem

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dec 2013, Volume 26 N. 6 Pages 575 - 580

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

4 downloads

15.

EpiFibro - um banco de dados nacional sobre a síndrome da fibromialgia: análise inicial de 500 mulheres
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Rezende, Marcelo C.

; Paiva, Eduardo S.

; Helfenstein Jr., Milton

; Ranzolin, Aline

; Martinez, José Eduardo

; Provenza, Jose Roberto

; Parolini, Carlos Eugênio Ribeiro

; Ribeiro, Luiz Severiano

; Souza, Eduardo J. R.

; Feldman, Daniel P.

; Assis, Marcos Renato de

; Heymann, Roberto E.

Revista Brasileira de Reumatologia

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oct 2013, Volume 53 N. 5 Pages 382 - 387

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: A fibromialgia (FM) é uma condição dolorosa do sistema musculoesquelético, geralmente acompanhada de vários sintomas em outros sistemas, com uma prevalência no Brasil estimada em 2,5%. Apresentamos os dados iniciais do EpiFibro, um banco de dados nacional de pacientes com FM atendidos em serviços públicos e privados. OBJETIVO: Avaliar como é feito o diagnóstico da doença, identificar um conjunto de domínios clínicos considerados relevantes por médicos e por pacientes com FM, analisar o impacto da doença na qualidade de vida dos pacientes e comparar os achados entre pacientes de serviços público e privado. MÉTODOS: Foram analisadas as respostas das primeiras 500 mulheres nesse banco de dados. Esse banco de dados foi baseado em um questionário contendo dados demográficos e clínicos. O Fibromyalgia Impact Questionnaire (FIQ), traduzido e validado para o Brasil, foi preenchido pelos médicos e/ou pacientes. RESULTADOS: Uma análise preliminar do banco de dados EpiFibro revelou que as pacientes com FM no Brasil têm um alto impacto da doença avaliada pelo FIQ, uma alta prevalência de sintomas associados, um baixo grau de educação (um achado que pode ser explicado pelo fato de a saúde pública no Brasil ser usada principalmente por aqueles desfavorecidos socialmente) e a maioria percebe a sua dor como sendo difusa a partir do início da doença. CONCLUSÃO: Depressão e ansiedade são percebidas como as principais causas dos sintomas da FM, mas uma quantidade significativa considera o esforço no trabalho como o primeiro gatilho. Há um atraso de poucos anos em busca de ajuda médica e para chegar ao reumatologista.

INTRODUCTION: Fibromyalgia syndrome (FS) is a common painful condition of the musculoskeletal system that is typically accompanied by several symptoms in other systems. In Brazil, the prevalence of FS is estimated at 2.5%. Here, we present the initial data from Epi-Fibro, a nationwide databank of FS patients seen in public and private settings. OBJECTIVE: The aims of this study were to assess how the diagnosis of FS was made, identify a set of clinical domains considered relevant by both clinicians and patients in cases of FS, analyse the impact of disease on patient quality of life, and compare the findings among patients of public and private services. METHODS: Based on the results of questionnaires, we analysed data corresponding to the first 500 women in the database. Questionnaires pertaining to demographic and clinical data and the Fibromyalgia Impact Questionnaire (FIQ), which was translated and validated for Brazilian patients, were completed by the clinicians and/or patients. RESULTS: Preliminary analysis of the EpiFibro databank revealed that female FS patients in Brazil reported a high impact of disease, as measured by the FIQ, a high prevalence of associated symptoms, and a low degree of education (consistent with the public health care in Brazil used mainly by the underserved). In addition, most patients perceived their pain as diffuse from the onset of disease. CONCLUSION: Depression and anxiety were seen as the main triggers of FM symptoms, but a significant proportion of the subjects perceived work strain as the initial trigger.We also observed a delay of a few years in seeking medical help and examination by a rheumatologist.

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