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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">As cardiopatias cong&#233;nitas podem ser designadas como sendo as altera&#231;&#245;es que ocorrem durante a gesta&#231;&#227;o na forma&#231;&#227;o do cora&#231;&#227;o&#44; assim como dos vasos sangu&#237;neos&#44; proporcionando deste modo malforma&#231;&#245;es card&#237;acas<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Gra&#231;as &#224; evolu&#231;&#227;o nos tratamentos cl&#237;nicos e cir&#250;rgicos foi poss&#237;vel aumentar a taxa de sobreviv&#234;ncia&#44; sendo que cerca de 85-90&#37; das crian&#231;as com uma cardiopatia cong&#233;nita podem agora viver at&#233; &#224; idade adulta com uma melhor qualidade de vida<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1-3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Uma vez que a evolu&#231;&#227;o m&#233;dica a diversos n&#237;veis tem sido not&#225;vel e tem permitido que os pacientes portadores desta patologia vivam cada vez mais anos e com menores limita&#231;&#245;es decorrentes da sua cardiopatia&#44; as quest&#245;es relativas &#224; sua adapta&#231;&#227;o &#224; doen&#231;a cada vez emergem com maior destaque<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Assim&#44; &#233; imperativo compreender quais os efeitos decorrentes de uma cardiopatia cong&#233;nita a v&#225;rios n&#237;veis&#44; uma vez que os resultados dispon&#237;veis na literatura apresentam conclus&#245;es contradit&#243;rias<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5-8</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Ainda que alguns estudos apresentem uma tend&#234;ncia &#224; exist&#234;ncia de problemas comportamentais ou emocionais nestes pacientes<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;9&#44;10</span></a>&#44; outros dados revelam um funcionamento psicol&#243;gico adaptativo nos adultos com cardiopatias cong&#233;nitas<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Da mesma forma&#44; a gravidade da cardiopatia parece estar relacionada com pior ajustamento psicossocial e tend&#234;ncia a morbilidade psiqui&#225;trica<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;9</span></a>&#44; enquanto outros autores n&#227;o corroboram esta posi&#231;&#227;o<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Tamb&#233;m na qualidade de vida se verificam resultados distintos&#44; uma vez que enquanto alguns apresentam pior bem-estar psicol&#243;gico e qualidade de vida quando comparados com a popula&#231;&#227;o saud&#225;vel<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;12</span></a>&#44; outros n&#227;o atribuem uma rela&#231;&#227;o entre a presen&#231;a de cardiopatia e uma menor qualidade de vida&#44; encontrando valores semelhantes aos valores encontrados na popula&#231;&#227;o saud&#225;vel<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Este estudo pretende avaliar o ajustamento psicossocial&#44; a propens&#227;o para a psicopatologia e a qualidade de vida numa popula&#231;&#227;o de adolescentes e jovens adultos com cardiopatias cong&#233;nitas&#44; com ou sem corre&#231;&#227;o cir&#250;rgica e&#44; tamb&#233;m&#44; tentar clarificar a influ&#234;ncia de algumas vari&#225;veis demogr&#225;ficas e cl&#237;nicas&#44; aumentando a resili&#234;ncia e favorecendo a adapta&#231;&#227;o&#44; ou&#44; pelo contr&#225;rio&#44; dificultando o ajustamento e o bem-estar&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Popula&#231;&#227;o e m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Participaram neste estudo 74 pacientes com cardiopatias cong&#233;nitas&#44; tendo a recolha sido efetuada num &#250;nico momento temporal&#44; ou seja&#44; quando os pacientes se deslocavam ao hospital para a consulta de cardiologia pedi&#225;trica ou de cardiologia&#44; sendo abordados para participar no estudo&#46; Ap&#243;s terem sido informados de todos os aspetos inerentes ao estudo&#44; os pacientes que eram maiores de idade ou os cuidadores&#44; no caso de os pacientes serem menores de idade&#44; assinavam um termo de consentimento informado&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Dos 74 pacientes&#44; 41 eram do sexo masculino e 33 do sexo feminino&#46; A idade m&#233;dia dos participantes situou-se em torno dos 18&#44;76 anos &#40;&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;86&#41;&#44; com uma varia&#231;&#227;o de idades entre os 12-26 anos&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A gravidade da cardiopatia cong&#233;nita era complexa em 27 participantes&#44; moderada em 13 e menor em 34&#46; Relativamente &#224; severidade de les&#245;es residuais&#44; quatro apresentavam les&#245;es graves&#44; 18 moderadas e 52 leves&#46; Em rela&#231;&#227;o &#224; presen&#231;a de psicopatologia&#44; 17 participantes &#40;23&#37; do total&#41; revelaram pelo menos um tipo de psicopatologia durante a sua vida&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Do total de participantes&#44; 40 foram diagnosticados durante o per&#237;odo neonatal&#44; 28 at&#233; ao primeiro ano de vida&#44; tr&#234;s foram diagnosticados entre o primeiro e o terceiro ano de vida e tr&#234;s obtiveram um diagn&#243;stico entre os tr&#234;s e os seis anos de idade&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">No que diz respeito &#224; idade em que foi realizada a primeira interven&#231;&#227;o cir&#250;rgica&#44; para os participantes que foram submetidos a este tipo de interven&#231;&#245;es&#44; verificou-se que dois foram intervencionados durante o per&#237;odo neonatal&#44; 24 at&#233; ao primeiro ano de vida&#44; 15 entre o primeiro e o terceiro ano de vida&#44; 16 entre os tr&#234;s e os seis anos de idade e tr&#234;s entre os seis e os 12 anos&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">No que se refere ao n&#237;vel de escolaridade&#44; nove tinham o segundo ciclo&#44; 27 o terceiro ciclo&#44; 33 o ensino secund&#225;rio e cinco o grau de licenciatura&#46; Em rela&#231;&#227;o ao estado civil&#44; a maioria dos participantes eram solteiros &#40;69&#41;&#44; dois eram casados&#44; dois viviam em uni&#227;o de facto e um era divorciado&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Participaram tamb&#233;m 64 cuidadores que acompanharam os pacientes &#224; consulta&#44; tendo-lhes sido solicitado que preenchessem um question&#225;rio&#46; Este n&#250;mero final resultou de que dez cuidadores se recusaram a participar ou n&#227;o se encontravam presentes no momento da aplica&#231;&#227;o do protocolo e&#44; posteriormente&#44; n&#227;o manifestaram inten&#231;&#227;o de participar&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Para a realiza&#231;&#227;o deste estudo foram utilizados como instrumentos uma ficha de identifica&#231;&#227;o&#44; uma entrevista semiestruturada&#44; uma entrevista psiqui&#225;trica estandardizada <span class="elsevierStyleItalic">Schedule for Affective Disorders and Schizophrenia &#8211; Lifetime version</span> &#40;SADS-L&#41;&#44; o <span class="elsevierStyleItalic">Youth Self Report</span> &#40;YSR&#41; e o <span class="elsevierStyleItalic">Child Behavior Checklist</span> &#40;CBCL&#41; para os pacientes cuja idade era inferior aos 18 anos&#46; Para os pacientes com idade superior aos 18 anos&#44; foi utilizado o <span class="elsevierStyleItalic">Adult Self Report</span> &#40;ASR&#41; e o <span class="elsevierStyleItalic">Adult Behavior Checklist</span> &#40;ABCL&#41;&#46; Foi ainda aplicado um question&#225;rio de qualidade de vida denominado question&#225;rio de avalia&#231;&#227;o da qualidade de vida &#40;WHOQOL-Bref&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Na ficha de identifica&#231;&#227;o era feito o registo das vari&#225;veis demogr&#225;ficas de cada participante&#44; mais concretamente&#44; os seus elementos pessoais&#44; como o estado civil&#44; a escolaridade e a profiss&#227;o&#44; al&#233;m de constarem todos os elementos relativos &#224; sua hist&#243;ria cl&#237;nica&#44; como o diagn&#243;stico e a gravidade&#44; tipo de cardiopatia&#44; descri&#231;&#227;o das cirurgias realizadas&#44; les&#245;es residuais e a necessidade de terapia farmacol&#243;gica&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">A entrevista semiestruturada aplicada abordava &#225;reas como o suporte social&#44; o ambiente familiar&#44; as limita&#231;&#245;es funcionais&#44; o percurso escolar e o autoconceito&#46; Esta entrevista &#233; composta por 38 quest&#245;es&#44; variando entre op&#231;&#245;es de resposta m&#250;ltipla e resposta curta&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A entrevista psiqui&#225;trica estandardizada SADS-L foi aplicada no sentido de verificar a exist&#234;ncia de psicopatologia nos pacientes com cardiopatias cong&#233;nitas&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">O YSR e o ASR s&#227;o question&#225;rios de autorresposta que permitem fazer uma descri&#231;&#227;o do funcionamento da crian&#231;a ou do adulto&#46; Para efeitos deste estudo&#44; em rela&#231;&#227;o a estes instrumentos foram recolhidas as respostas das escalas do isolamento&#44; queixas som&#225;ticas&#44; ansiedade&#47;depress&#227;o&#44; altera&#231;&#245;es do pensamento&#44; problemas de aten&#231;&#227;o&#44; comportamento delinquente&#44; comportamento agressivo&#44; internaliza&#231;&#227;o e externaliza&#231;&#227;o&#46; Os resultados referentes &#224; escala de problemas sociais do YSR n&#227;o foram inclu&#237;dos&#44; uma vez que n&#227;o possu&#237;a uma escala equiparada no ASR<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">O CBCL e o ABCL s&#227;o question&#225;rios destinados a serem preenchidos pelos pais ou cuidadores &#40;algu&#233;m que os conhe&#231;a bem&#41;&#44; pois as respostas descrevem a perce&#231;&#227;o do funcionamento ou comportamento dos pacientes&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Os resultados do YSR e do ASR&#44; bem como os resultados do CBCL e do ABCL&#44; foram agrupados por serem instrumentos muito semelhantes e para permitir juntar um n&#250;mero maior de respostas&#44; com mais representatividade&#44; sendo que&#44; para efeitos de tratamento estat&#237;stico&#44; foram contabilizados os resultados totais de cada escala&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">O WHOQOL-Bref &#233; um question&#225;rio para a avalia&#231;&#227;o subjetiva da qualidade de vida&#44; que pode ser aplicado quer a indiv&#237;duos saud&#225;veis quer a doentes com qualquer tipo de patologia<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Este question&#225;rio &#233; composto por 26 quest&#245;es&#44; com resposta do tipo <span class="elsevierStyleItalic">likert</span>&#44; podendo a cada quest&#227;o ser atribu&#237;da uma classifica&#231;&#227;o entre 1-5&#46; O valor 5 corresponde ao valor mais elevado&#44; excetuando nas quest&#245;es tr&#234;s&#44; quatro e 26&#44; que est&#227;o formuladas negativamente e onde o valor 5 corresponde ao valor mais baixo&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Para a an&#225;lise dos dados foi utilizado o <span class="elsevierStyleItalic">software IBM Social Package for the Social Sciences</span> &#40;SPSS&#41;&#44; <span class="elsevierStyleItalic">version</span> 19&#46;0&#44; tendo sido usado o teste t de <span class="elsevierStyleItalic">student</span> para vari&#225;veis param&#233;tricas e o teste Mann-Whitney para as vari&#225;veis n&#227;o param&#233;tricas&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0120" class="elsevierStylePara elsevierViewall">Na <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a> encontram-se as diferen&#231;as no ajustamento psicossocial entre os dois g&#233;neros&#44; no autorrelato&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Na <a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a> figuram as diferen&#231;as no ajustamento psicossocial entre os participantes com formas graves de CC comparados com os que t&#234;m formas moderadas ou ligeiras&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Na <a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a> figuram as diferen&#231;as no ajustamento psicossocial entre participantes submetidos a interven&#231;&#227;o cir&#250;rgica&#44; quando comparados com os que n&#227;o necessitaram de cirurgia&#44; avaliados pelos cuidadores&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0020">Tabela 4</a> relata as diferen&#231;as do ajustamento psicossocial entre participantes com percurso escolar satisfat&#243;rio e os que tiveram um percurso mal sucedido&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0025">Tabela 5</a> apresenta os resultados da preval&#234;ncia de diagn&#243;stico psiqui&#225;trico dos nossos participantes comparativamente com os valores de refer&#234;ncia de outros estudos&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">&#201; de salientar que as participantes de sexo feminino apresentavam uma preval&#234;ncia de psicopatologia mais de duas vezes superior aos de sexo masculino &#40;33&#44;3 e 14&#44;6&#37;&#44; respetivamente&#44; sendo a diferen&#231;a estatisticamente significativa&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Na <a class="elsevierStyleCrossRef" href="#tbl0030">Tabela 6</a> constam os dados relativos &#224; caracteriza&#231;&#227;o da amostra em todos os dom&#237;nios da QV&#44; sendo comparados com os valores de refer&#234;ncia para a popula&#231;&#227;o portuguesa&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Na <a class="elsevierStyleCrossRef" href="#tbl0035">Tabela 7</a> figuram as diferen&#231;as da qualidade de vida obtidas pelos pacientes que foram submetidos a interven&#231;&#227;o cir&#250;rgica comparativamente com os que n&#227;o foram submetidos a cirurgia&#46;</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0040">Tabela 8</a> descreve as diferen&#231;as de qualidade de vida entre grupos com bom suporte social e com m&#225; qualidade de suporte&#46;</p><elsevierMultimedia ident="tbl0040"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">Na <a class="elsevierStyleCrossRef" href="#tbl0045">Tabela 9</a> encontram-se as diferen&#231;as relativas &#224; qualidade de vida&#44; entre participantes com percurso escolar satisfat&#243;rio e insatisfat&#243;rio&#46;</p><elsevierMultimedia ident="tbl0045"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">&#201; ainda importante referir que 51&#44;4&#37; dos participantes do nosso estudo tiveram reprova&#231;&#245;es na escola &#40;com m&#233;dia de 1&#44;74 anos<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#44;86&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discuss&#227;o</span><p id="par0175" class="elsevierStylePara elsevierViewall">Neste estudo&#44; os pacientes de sexo feminino apresentaram de forma estatisticamente significativa mais queixas som&#225;ticas&#44; maiores &#237;ndices de ansiedade e de depress&#227;o&#44; mais altera&#231;&#245;es do pensamento&#44; mais comportamentos agressivos&#44; bem como maior grau de internaliza&#231;&#227;o e&#44; portanto&#44; pior ajustamento psicossocial&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">As diferen&#231;as verificadas entre os sexos nos pacientes com cardiopatias cong&#233;nitas poder&#227;o estar relacionadas com a presen&#231;a de uma cicatriz localizada no peito&#44; resultante da interven&#231;&#227;o cir&#250;rgica&#44; podendo afetar a imagem corporal e a autoestima e revelar-se como um fator de inseguran&#231;a e de incerteza no relacionamento interpessoal e sexual&#46; Para al&#233;m da cicatriz&#44; outro aspeto que pode constituir-se como um fator de inseguran&#231;a para as pacientes com cardiopatias cong&#233;nitas reside na possibilidade da doen&#231;a card&#237;aca interferir na sua capacidade reprodutiva e com o parto<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6&#44;20</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">De salientar que os pacientes do sexo feminino tendem tamb&#233;m a apresentar &#237;ndices mais elevados de preocupa&#231;&#227;o nos aspetos relacionados com o seu corpo&#44; quando comparados com o sexo masculino<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Tamb&#233;m revelam uma tend&#234;ncia para apresentar n&#237;veis superiores de ansiedade&#47;depress&#227;o perante obst&#225;culos que interferem a n&#237;vel interpessoal&#44; o que se traduz em n&#237;veis superiores de internaliza&#231;&#227;o<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">As participantes do nosso estudo evidenciaram&#44; assim&#44; um risco superior para apresentar problemas emocionais e comportamentais&#44; quando comparadas com os participantes do sexo masculino<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Os pacientes com cardiopatias cong&#233;nitas complexas manifestavam em autorrelato mais queixas som&#225;ticas&#44; mais altera&#231;&#245;es do pensamento e tamb&#233;m &#237;ndices mais elevados de internaliza&#231;&#227;o&#44; quando comparados com os pacientes com cardiopatias cong&#233;nitas menores ou moderadas&#46; Os resultados obtidos parecem sugerir que os adolescentes e jovens adultos com cardiopatias cong&#233;nitas complexas apresentam pior ajustamento psicossocial&#44; podendo este facto estar associado &#224; necessidade de estes pacientes requererem mais cuidados a n&#237;vel m&#233;dico no decurso da sua vida&#44; enquanto os adolescentes e jovens adultos com cardiopatias cong&#233;nitas leves ou moderadas poder&#227;o manter uma vida di&#225;ria id&#234;ntica &#224; de outras pessoas da mesma idade consideradas saud&#225;veis<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;22</span></a>&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Tendo em considera&#231;&#227;o que as cardiopatias complexas apresentam um maior risco para os indiv&#237;duos&#44; quando comparadas com as cardiopatias menores ou moderadas&#44; &#233; compreens&#237;vel que os adolescentes e jovens adultos que t&#234;m uma forma complexa apresentem mais queixas som&#225;ticas&#44; estando estas associadas ao facto de os pacientes se encontrarem mais vigilantes para os sinais emitidos pelo seu corpo&#46; Estes sinais tendem a interferir com o seu pensamento&#44; tornando-se&#44; deste modo&#44; mais ansiosos relativamente a poss&#237;veis complica&#231;&#245;es que possam surgir &#40;a ansiedade &#233; uma das componentes da escala de internaliza&#231;&#227;o&#41;&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Quando avaliados pelos cuidadores&#44; os adolescentes e jovens adultos que n&#227;o tinham sido submetidos a interven&#231;&#245;es cir&#250;rgicas apresentavam mais queixas som&#225;ticas&#44; assim como altera&#231;&#245;es do pensamento comparativamente com os adolescentes e jovens adultos que foram sujeitos a interven&#231;&#245;es cir&#250;rgicas&#46; Os resultados obtidos no estudo revelam que as interven&#231;&#245;es cir&#250;rgicas exercem um papel preponderante para melhorar a qualidade de vida dos pacientes com cardiopatias cong&#233;nitas<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;23</span></a>&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">A doen&#231;a card&#237;aca cong&#233;nita implica um acompanhamento m&#233;dico regular&#44; sendo que&#44; por esta raz&#227;o&#44; muitos dos pacientes necessitam de faltar mais &#224; escola&#46; Este afastamento tem como consequ&#234;ncia a diminui&#231;&#227;o do rendimento acad&#233;mico&#44; ansiedade&#47;depress&#227;o&#44; problemas de aten&#231;&#227;o&#44; &#237;ndices superiores de internaliza&#231;&#227;o e de externaliza&#231;&#227;o&#44; sendo que estes aspetos corroboram os dados obtidos no estudo&#44; ou seja&#44; os pacientes que apresentavam um percurso escolar insatisfat&#243;rio apresentavam pior ajustamento psicossocial<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;23-26</span></a>&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">No que se refere &#224; morbilidade psiqui&#225;trica&#44; 23&#37; dos pacientes apresentavam diagn&#243;stico psiqui&#225;trico&#46; Tendo por base o valor de refer&#234;ncia de 10&#37; apresentado pela Organiza&#231;&#227;o Mundial de Sa&#250;de &#40;OMS&#41; para a popula&#231;&#227;o mundial saud&#225;vel&#44; os resultados sugerem que os adolescentes e jovens adultos com cardiopatias cong&#233;nitas poder&#227;o ter mais propens&#227;o para a psicopatologia<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Contudo&#44; quando comparada a nossa preval&#234;ncia &#40;23&#37;&#41; com os valores apontados por um estudo que re&#250;ne os dados de seis pa&#237;ses europeus &#40;25&#37;&#41; no que diz respeito &#224; presen&#231;a de algum tipo de perturba&#231;&#227;o mental&#44; pode constatar-se uma semelhan&#231;a nos resultados obtidos<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Num outro estudo foram tamb&#233;m encontrados resultados semelhantes de preval&#234;ncia de desordens mentais em Espanha &#40;19&#44;4&#37;&#41;&#44; It&#225;lia &#40;18&#44;1&#37;&#41; e Alemanha &#40;25&#44;2&#37;&#41;&#44; embora estes se contraponham aos n&#250;meros mais d&#237;spares para Fran&#231;a &#40;37&#44;9&#37;&#41; e Estados Unidos da Am&#233;rica &#40;47&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Seria&#44; por&#233;m&#44; pertinente e desej&#225;vel comparar a preval&#234;ncia de psicopatologia nos nossos doentes com valores obtidos para a popula&#231;&#227;o portuguesa&#44; o que n&#227;o &#233; poss&#237;vel por n&#227;o estarem ainda dispon&#237;veis&#44; sendo esta uma das limita&#231;&#245;es mais importantes do nosso estudo&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Comparando as participantes de sexo feminino com os de sexo masculino&#44; verificamos mais do dobro da preval&#234;ncia nas primeiras&#44; o que &#233; consistente com o pior ajustamento psicossocial tamb&#233;m verificado e com a preval&#234;ncia de psicopatologia &#40;sobretudo de tipo depressivo e ansioso&#41; reportadas em estudos populacionais de v&#225;rios pa&#237;ses&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Neste estudo&#44; foi poss&#237;vel verificar que a popula&#231;&#227;o de pacientes com cardiopatias cong&#233;nitas revelava uma melhor perce&#231;&#227;o da sua qualidade de vida&#44; comparativamente com os valores de refer&#234;ncia da popula&#231;&#227;o saud&#225;vel portuguesa nos dom&#237;nios das rela&#231;&#245;es sociais e ambiente&#46; Outros autores tamb&#233;m verificaram uma menor qualidade de vida comparativamente com a popula&#231;&#227;o normal&#44; sobretudo a n&#237;vel do dom&#237;nio f&#237;sico e no dom&#237;nio da qualidade de vida geral do WHOQOL-BREF&#44; enquanto tamb&#233;m se verificam diferen&#231;as nos dom&#237;nios psicol&#243;gico e social&#44; mas n&#227;o com uma diferen&#231;a t&#227;o expressiva<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Os indiv&#237;duos que n&#227;o foram submetidos a qualquer tipo de interven&#231;&#227;o cir&#250;rgica obtiveram melhor qualidade de vida ao n&#237;vel f&#237;sico&#44; de rela&#231;&#245;es sociais e geral&#44; na autoavalia&#231;&#227;o&#44; quando comparados com participantes sujeitos a cirurgia&#40;s&#41;&#46; Ainda que a grande parte dos pacientes com cardiopatias cong&#233;nitas sujeitos a corre&#231;&#245;es cir&#250;rgicas tendam a conseguir um funcionamento normal nos v&#225;rios vetores da sua vida&#44; s&#227;o colocados em jogo alguns desafios desenvolvimentais nos casos em que a cardiopatia tem uma gravidade complexa ou moderada&#44; o que dificulta o planeamento a longo prazo do futuro dos pacientes<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">O suporte social revelou uma grande influ&#234;ncia na qualidade de vida&#44; uma vez que os indiv&#237;duos com melhor suporte social apresentam melhor qualidade de vida em todos os dom&#237;nios avaliados&#44; mais concretamente f&#237;sico&#44; psicol&#243;gico&#44; rela&#231;&#245;es sociais&#44; ambiente e qualidade de vida geral&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">O suporte social&#44; seja a n&#237;vel individual&#44; da fam&#237;lia ou da comunidade &#233; um dos recursos prim&#225;rios com um efeito mais significativo&#44; mesmo como mediador de extrema import&#226;ncia entre <span class="elsevierStyleItalic">stress</span> e bem-estar psicol&#243;gico<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; &#201; tamb&#233;m importante destacar o papel atribu&#237;do ao suporte social&#44; uma vez que a perce&#231;&#227;o da disponibilidade de suporte social &#233; muito importante para diminuir os efeitos do <span class="elsevierStyleItalic">stress</span> a n&#237;vel dos problemas de sa&#250;de&#44; seja a n&#237;vel f&#237;sico ou psicol&#243;gico<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; Os indiv&#237;duos com um percurso escolar satisfat&#243;rio apresentam melhor qualidade de vida a n&#237;vel f&#237;sico&#44; ambiente e qualidade de vida geral&#44; al&#233;m de uma tend&#234;ncia para melhor qualidade de vida a n&#237;vel psicol&#243;gico&#46; O desempenho escolar pode ser altamente afetado pelas cardiopatias cong&#233;nitas&#44; j&#225; que a necessidade de hospitaliza&#231;&#245;es e de restri&#231;&#227;o das atividades com os colegas pode implicar afastamentos regulares da atividade escolar<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;29</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclus&#245;es</span><p id="par0260" class="elsevierStylePara elsevierViewall">Os resultados obtidos neste estudo parecem evidenciar que os adolescentes e jovens adultos com cardiopatias cong&#233;nitas apresentam uma predisposi&#231;&#227;o para apresentar problemas emocionais e comportamentais&#46; Entre eles&#44; os pacientes que parecem sofrer mais com os efeitos decorrentes do ajustamento psicossocial s&#227;o os pacientes do sexo feminino&#44; os pacientes com cardiopatias cong&#233;nitas complexas&#44; os pacientes que n&#227;o foram sujeitos a interven&#231;&#245;es cir&#250;rgicas &#40;opini&#227;o dos cuidadores&#41; e os pacientes com um percurso escolar insatisfat&#243;rio&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Os dados obtidos sobre morbilidade psiqui&#225;trica nesta popula&#231;&#227;o parecem indicar uma propens&#227;o ligeiramente mais alta para ser afetado por dist&#250;rbio psicopatol&#243;gico&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Al&#233;m disso&#44; os participantes deste estudo revelaram uma melhor qualidade de vida comparativamente &#224; popula&#231;&#227;o portuguesa&#44; tendo-se destacado o papel do suporte social&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">No entanto&#44; ainda que os v&#225;rios tipos de suporte social tenham um papel de destaque&#44; o facto de ser um tipo de doen&#231;a diagnosticada numa fase inicial da sua vida faz com que os pacientes tenham de p&#244;r em jogo todas as suas compet&#234;ncias para conseguirem fazer face &#224;s tarefas do desenvolvimento normativo e viver uma vida normal&#44; com algumas limita&#231;&#245;es que s&#227;o suplantadas com recurso &#224;s estrat&#233;gias de <span class="elsevierStyleItalic">coping</span> que elaboraram&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Financiamento</span><p id="par0280" class="elsevierStylePara elsevierViewall">Esta investiga&#231;&#227;o teve o financiamento da CESPU&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflito de interesses</span><p id="par0285" class="elsevierStylePara elsevierViewall">Esta investiga&#231;&#227;o teve o financiamento da CESPU&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Agradecimentos</span><p id="par0290" class="elsevierStylePara elsevierViewall">Esta investiga&#231;&#227;o teve o financiamento da CESPU&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Caracterizar a popula&#231;&#227;o de adolescentes e jovens adultos com cardiopatias cong&#233;nitas &#40;<span class="elsevierStyleSmallCaps">CC</span>&#41; ao n&#237;vel do seu ajustamento psicossocial e morbilidade psiqui&#225;trica&#44; bem como avaliar a qualidade de vida &#40;QV&#41;&#44; para perceber quais s&#227;o as vari&#225;veis com impacto na vida e na adapta&#231;&#227;o &#224; doen&#231;a&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Popula&#231;&#227;o e m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Participaram 74 pacientes com CC&#44; sendo 41 do sexo masculino e 33 do sexo feminino&#44; com idades entre 12-26 &#40;m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#44;76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;86&#41;&#46; Foram recolhidos os dados demogr&#225;ficos e cl&#237;nicos mais relevantes dos pacientes e foi aplicado um conjunto de instrumentos&#44; incluindo uma entrevista semiestruturada sobre t&#243;picos de suporte social&#44; estilo de educa&#231;&#227;o na fam&#237;lia&#44; autoimagem e limita&#231;&#245;es f&#237;sicas&#44; uma entrevista psiqui&#225;trica estandardizada e question&#225;rios para avaliar o ajustamento psicossocial na forma de autorrelato &#40;YSR e ASR&#41; e relato dos cuidadores &#40;CBCL e ABCL&#41;&#44; bem como um question&#225;rio de avalia&#231;&#227;o da qualidade de vida &#40;WHOQOL-BREF&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">O sexo feminino relatou mais ansiedade&#47;depress&#227;o &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>952&#44;500&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#44; altera&#231;&#245;es do pensamento &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>929&#44;500&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; e comportamento agressivo &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>999&#44;000&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41;&#46; Pacientes com CC complexas relataram mais altera&#231;&#245;es de pensamento &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>442&#44;000&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41; e internaliza&#231;&#227;o &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>429&#44;000&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;021&#41;&#46; Comparativamente com a popula&#231;&#227;o portuguesa&#44; os nossos participantes apresentaram melhor QV nos dom&#237;nios rela&#231;&#245;es sociais &#40;t<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;333&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;022&#41; e ambiente &#40;t<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;754&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41;&#46; Os pacientes que n&#227;o foram submetidos a interven&#231;&#245;es cir&#250;rgicas revelaram melhor QV nos dom&#237;nios f&#237;sico &#40;t<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;1&#44;989&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;050&#41;&#44; de rela&#231;&#245;es sociais &#40;t<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;2&#44;012&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;048&#41; e QV geral &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>563&#44;000&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;037&#41;&#46; A presen&#231;a de um melhor suporte social est&#225; relacionada com uma melhor QV nos pacientes em todos os dom&#237;nios avaliados&#44; com destaque para o f&#237;sico &#40;t<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;287&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; e rela&#231;&#245;es sociais &#40;t<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;669&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41;&#46; Um melhor desempenho acad&#233;mico encontrava-se tamb&#233;m associado com uma melhor perce&#231;&#227;o de QV global &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>457<span class="elsevierStyleHsp" style=""></span>000&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;046&#41;&#44; com menos tend&#234;ncia ao isolamento &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>812&#46;500&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;031&#41;&#44; menos sentimentos de ansiedade e de depress&#227;o &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>854<span class="elsevierStyleHsp" style=""></span>000&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&#44; menos problemas de aten&#231;&#227;o &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>903<span class="elsevierStyleHsp" style=""></span>500&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; e valores mais baixos de internaliza&#231;&#227;o &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>817<span class="elsevierStyleHsp" style=""></span>000&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;029&#41; e de externaliza&#231;&#227;o &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>803<span class="elsevierStyleHsp" style=""></span>500&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;042&#41;&#46; As limita&#231;&#245;es f&#237;sicas tinham um efeito nocivo no QV &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>947<span class="elsevierStyleHsp" style=""></span>500&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Discuss&#227;o</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">As participantes do sexo feminino evidenciaram pior ajustamento psicossocial e maior propens&#227;o &#224; psicopatologia&#46; As CC complexas exigem mais cuidados regulares&#44; limitando o contacto social com pares&#44; a integra&#231;&#227;o escolar e de lazer&#44; e dificultando a adapta&#231;&#227;o&#46; A realiza&#231;&#227;o de cirurgias influencia a QV dos pacientes&#44; pela exig&#234;ncia de mais cuidados m&#233;dicos&#44; induzindo maiores limita&#231;&#245;es na sua vida di&#225;ria&#44; o que dificulta a aquisi&#231;&#227;o de uma rede de suporte social satisfat&#243;ria&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclus&#245;es</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Os pacientes com CC evidenciaram uma maior tend&#234;ncia a apresentar psicopatologia&#44; sendo o sexo feminino mais predisposto a sofrer com os efeitos do desajustamento psicossocial&#46; O suporte social revelou um papel preponderante no ajustamento dos doentes&#46;</p>"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Objectives</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We aimed to study the psychosocial adjustment &#40;PSA&#41;&#44; psychiatric morbidity and quality of life of adolescents and young adults with congenital heart disease &#40;CHD&#41; to determine which demographic and clinical variables negatively affect adjustment and which increase resilience&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Methods</span><p id="spar0150" class="elsevierStyleSimplePara elsevierViewall">The study included 74 patients with CHD&#44; 41 male and 33 female&#44; aged between 12 and 26 years &#40;mean 18&#46;76&#177;3&#46;86&#41;&#46; Demographic information and a complete clinical history were obtained&#46; The participants were interviewed regarding social support&#44; family environment&#44; self-image and physical limitations&#46; A standardized psychiatric interview was conducted&#44; and self-report questionnaires were administered for assessment of PSA &#40;Youth Self Report and Adult Self Report&#41; and quality of life &#40;World Health Organization Quality of Life &#8211; Short Version&#41;&#46; A caregiver completed an observational version of the PSA questionnaire &#40;Child Behavior Checklist or Adult Behavior Checklist&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0155" class="elsevierStyleSimplePara elsevierViewall">Female participants showed more feelings of anxiety and depression &#40;U&#61;952&#46;500&#59; p&#61;0&#46;003&#41;&#44; thought problems &#40;U&#61;929&#46;500&#59; p&#61;0&#46;005&#41; and aggressive behavior &#40;U&#61;999&#46;000&#59; p&#61;0&#46;000&#41;&#46; They also showed a higher rate of psychopathology&#46; Patients with complex forms of CHD reported more thought problems &#40;U&#61;442&#46;000&#59; p&#61;0&#46;027&#41; and internalization &#40;U&#61;429&#46;000&#59; p&#61;0&#46;021&#41;&#46; Compared to the Portuguese population as a whole&#44; participants showed better quality of life in the domains of social relationships &#40;t&#61;2&#46;333&#59; p&#61;0&#46;022&#41; and environment &#40;t&#61;3&#46;754&#59; p&#61;0&#46;000&#41;&#46; Patients who had undergone surgery had worse quality of life in physical terms &#40;t&#61;-1&#46;989&#59; p&#61;0&#46;050&#41;&#44; social relationships &#40;t&#61;-2&#46;012&#59; p&#61;0&#46;048&#41; and general quality of life &#40;U&#61;563&#46;000&#59; p&#61;0&#46;037&#41;&#44; compared to those who were not operated&#46; Better social support was associated with better quality of life in physical terms &#40;t&#61;3&#46;287&#59; p&#61;0&#46;002&#41; and social relationships &#40;t&#61;3&#46;669&#59; p&#61;0&#46;000&#41;&#46; Better school performance was also associated with better overall quality of life &#40;U&#61;457&#46;000&#59; p&#61;0&#46;046&#41;&#44; less withdrawn behavior &#40;U&#61;812&#46;500&#59; p&#61;0&#46;031&#41;&#44; fewer feelings of anxiety and depression &#40;U&#61;854&#46;000&#59; p&#61;0&#46;009&#41;&#44; fewer attention problems &#40;U&#61;903&#46;500&#59; p&#61;0&#46;001&#41;&#44; and lower scores for internalization &#40;U&#61;817&#46;000&#59; p&#61;0&#46;029&#41; and externalization &#40;U&#61;803&#46;500&#59; p&#61;0&#46;042&#41;&#46; Physical limitations had a detrimental effect on quality of life &#40;U&#61;947&#46;500&#59; p&#61;0&#46;001&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="spar0160" class="elsevierStyleSimplePara elsevierViewall">Female participants were more prone to worse psychological adjustment and to psychopathology&#46; Patients with complex forms of CHD showed worse PSA&#44; as they need regular care&#44; which restricts social contact with peers and family and integration in school and leisure activities&#46; Patients who had undergone surgery showed worse quality of life as they often have long hospital stays&#44; during which social activities are restricted&#44; making it more difficult for them to develop a good social support network&#46; They require close medical care&#44; and the restrictions on their activities may be life-limiting&#46; Their sense of survival may also be threatened&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0165" class="elsevierStyleSimplePara elsevierViewall">Patients with CHD appear to be more prone to psychopathology and female patients are more likely to show worse PSA&#46; Social support was shown to play a crucial role in buffering stress and promoting patients&#8217; adjustment&#46;</p>"
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Teste de Mann-Whitney para as diferen&#231;as entre g&#233;nero nas dimens&#245;es do ajustamento psicossocial&#44; no autorrelato</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">A&#47;D&#58; ansiedade&#47;depress&#227;o&#59; AP&#58; altera&#231;&#245;es do pensamento&#59; AR&#58; auto relato&#59; C&#58; complexa&#59; CA&#58; comportamento agressivo&#59; CD&#58; comportamento delinquente&#59; Ext&#58; externaliza&#231;&#227;o&#59; I&#58; isolamento&#59; Int&#58; internaliza&#231;&#227;o&#59; M&#47;m&#58; moderada ou menor&#59; p&#58; n&#237;vel de signific&#226;ncia&#59; PA&#58; problemas de aten&#231;&#227;o&#59; QS&#58; queixas som&#225;ticas&#59; u&#58; u de Mann Whitney&#46;</p><p id="spar0175" class="elsevierStyleSimplePara elsevierViewall">Negritos&#58; valores com signific&#226;ncia estat&#237;stica&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleBold">903&#44;500</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">40&#44;25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">36&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">695&#44;500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;410&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">CA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">41&#44;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">722&#44;500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;263&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Int&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">44&#44;92</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">33&#44;48</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">817&#44;000</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ext&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">44&#44;40</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">33&#44;76</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">803&#44;500</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;042</span>&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Teste de Mann-Whitney para as diferen&#231;as nas dimens&#245;es do ajustamento psicossocial entre participantes com percurso escolar satisfat&#243;rio e os que tiveram um percurso mal sucedido&#44; no autorrelato</p>"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Fontes&#58; World Health Organization<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#44; Alonso et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#44; Kessler et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Diagn&#243;stico psiqui&#225;trico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n &#40;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Sem diagn&#243;stico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">77&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;4<span class="elsevierStyleSup">c</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#44;9<span class="elsevierStyleSup">d</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#44;1<span class="elsevierStyleSup">e</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">25&#44;2<span class="elsevierStyleSup">f</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44;4<span class="elsevierStyleSup">g</span>&nbsp;\t\t\t\t\t\t\n
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Percentagem da popula&#231;&#227;o adulta mundial com desordens mentais e comportamentais&#44; definida pela Organiza&#231;&#227;o Mundial de Sa&#250;de &#40;OMS&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Percentagem de popula&#231;&#227;o com algum tipo de perturba&#231;&#227;o mental&#44; de acordo com os dados do projeto ESEMeD em seis pa&#237;ses Europeus&#46;</p> <p class="elsevierStyleNotepara" id="npar0015"><span class="elsevierStyleSup">c&#44;d&#44;e&#44;f&#44;g</span> Percentagem da popula&#231;&#227;o com algum tipo de perturba&#231;&#227;o nos pa&#237;ses Espanha&#44; Fran&#231;a&#44; It&#225;lia&#44; Alemanha e Estados Unidos da Am&#233;rica&#44; respetivamente&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Preval&#234;ncia de diagn&#243;stico psiqui&#225;trico nos participantes do nosso estudo comparativamente com os valores de refer&#234;ncia para diversas popula&#231;&#245;es</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0030"
        "etiqueta" => "Tabela 6"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">A&#58; dom&#237;nio ambiente da QV&#59; DP&#58; desvio padr&#227;o&#59; F&#58; dom&#237;nio f&#237;sico da QV&#59; G&#58; QV geral&#59; M&#58; m&#233;dia&#59; p&#58; n&#237;vel de signific&#226;ncia&#59; P&#58; dom&#237;nio psicol&#243;gico da QV&#59; PE&#58; popula&#231;&#227;o do estudo&#59; RS&#58; dom&#237;nio rela&#231;&#245;es sociais da QV&#59; t&#58; t de Student&#59; VR&#58; valores de refer&#234;ncia para a popula&#231;&#227;o saud&#225;vel portuguesa&#46;</p><p id="spar0200" class="elsevierStyleSimplePara elsevierViewall">Negritos&#58; valores com signific&#226;ncia estat&#237;stica&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">VR</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">PE</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">t&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">0&#44;153&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Teste T de Student para os quatro dom&#237;nios da QV e teste de Mann-Whitney para a QV Geral&#44; comparando doentes que foram submetidos a cirurgia com os que n&#227;o tiveram interven&#231;&#245;es</p>"
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">u&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Teste T de Student para os quatro dom&#237;nios da QV e teste de Mann-Whitney para a QV Geral&#44; comparando os participantes com bom suporte social com os que tinham suporte insuficiente</p>"
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          "leyenda" => "<p id="spar0145" class="elsevierStyleSimplePara elsevierViewall">A&#58; dom&#237;nio ambiente da QV&#59; DP&#58; desvio padr&#227;o&#59; F&#58; dom&#237;nio f&#237;sico da QV&#59; G&#58; QV geral&#59; M&#58; m&#233;dia&#59; p&#58; n&#237;vel de signific&#226;ncia&#59; P&#58; dom&#237;nio psicol&#243;gico da QV&#59; PES&#58; percurso escolar satisfat&#243;rio&#59; PEI&#58; percurso escolar insatisfat&#243;rio&#59; RS&#58; Dom&#237;nio Rela&#231;&#245;es Sociais da QV&#59; t&#58; t de Student&#59; u&#58; u de Mann-Whitney&#46;</p><p id="spar0230" class="elsevierStyleSimplePara elsevierViewall">Negritos&#58; valores com signific&#226;ncia estat&#237;stica&#46;</p>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;018</span>&nbsp;\t\t\t\t\t\t\n
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            1 => array:2 [
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Ajustamento psicossocial, morbilidade psiquiátrica e qualidade de vida em adolescentes e jovens adultos com cardiopatias congénitas
Psychosocial adjustment, psychiatric morbidity and quality of life in adolescents and young adults with congenital heart disease
Rosália Coelhoa,b, Flávio Teixeiraa,b, Ana Margarida Silvaa,b, Cláudia Vaza,b, Daniela Vieiraa,b, Cidália Proençaa,b, Cláudia Mourac,d,e, Victor Vianad,f, José Carlos Areiasc,d,e, Maria Emília Guimarães Areiasa,g,
Autor para correspondência
memilia.areias@cespu.pt

Autor para correspondência.
a Departamento de Psicologia, Instituto Superior de Ciências da Saúde do Norte (CESPU), Gandra, Portugal
b UNIPSA/CICS (CESPU), Unidade de Investigação de Psicologia e Saúde, Gandra, Portugal
c Serviço de Cardiologia Pediátrica, Departamento de Pediatria, Hospital São João, Porto, Portugal
d Departamento de Pediatria, Hospital São João, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
e Unidade de Investigação Cardiovascular, Porto, Portugal
f Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Portugal
g CINEICC, Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo-Comportamental, Porto, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">As cardiopatias cong&#233;nitas podem ser designadas como sendo as altera&#231;&#245;es que ocorrem durante a gesta&#231;&#227;o na forma&#231;&#227;o do cora&#231;&#227;o&#44; assim como dos vasos sangu&#237;neos&#44; proporcionando deste modo malforma&#231;&#245;es card&#237;acas<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Gra&#231;as &#224; evolu&#231;&#227;o nos tratamentos cl&#237;nicos e cir&#250;rgicos foi poss&#237;vel aumentar a taxa de sobreviv&#234;ncia&#44; sendo que cerca de 85-90&#37; das crian&#231;as com uma cardiopatia cong&#233;nita podem agora viver at&#233; &#224; idade adulta com uma melhor qualidade de vida<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1-3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Uma vez que a evolu&#231;&#227;o m&#233;dica a diversos n&#237;veis tem sido not&#225;vel e tem permitido que os pacientes portadores desta patologia vivam cada vez mais anos e com menores limita&#231;&#245;es decorrentes da sua cardiopatia&#44; as quest&#245;es relativas &#224; sua adapta&#231;&#227;o &#224; doen&#231;a cada vez emergem com maior destaque<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Assim&#44; &#233; imperativo compreender quais os efeitos decorrentes de uma cardiopatia cong&#233;nita a v&#225;rios n&#237;veis&#44; uma vez que os resultados dispon&#237;veis na literatura apresentam conclus&#245;es contradit&#243;rias<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5-8</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Ainda que alguns estudos apresentem uma tend&#234;ncia &#224; exist&#234;ncia de problemas comportamentais ou emocionais nestes pacientes<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;9&#44;10</span></a>&#44; outros dados revelam um funcionamento psicol&#243;gico adaptativo nos adultos com cardiopatias cong&#233;nitas<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Da mesma forma&#44; a gravidade da cardiopatia parece estar relacionada com pior ajustamento psicossocial e tend&#234;ncia a morbilidade psiqui&#225;trica<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;9</span></a>&#44; enquanto outros autores n&#227;o corroboram esta posi&#231;&#227;o<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Tamb&#233;m na qualidade de vida se verificam resultados distintos&#44; uma vez que enquanto alguns apresentam pior bem-estar psicol&#243;gico e qualidade de vida quando comparados com a popula&#231;&#227;o saud&#225;vel<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;12</span></a>&#44; outros n&#227;o atribuem uma rela&#231;&#227;o entre a presen&#231;a de cardiopatia e uma menor qualidade de vida&#44; encontrando valores semelhantes aos valores encontrados na popula&#231;&#227;o saud&#225;vel<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Este estudo pretende avaliar o ajustamento psicossocial&#44; a propens&#227;o para a psicopatologia e a qualidade de vida numa popula&#231;&#227;o de adolescentes e jovens adultos com cardiopatias cong&#233;nitas&#44; com ou sem corre&#231;&#227;o cir&#250;rgica e&#44; tamb&#233;m&#44; tentar clarificar a influ&#234;ncia de algumas vari&#225;veis demogr&#225;ficas e cl&#237;nicas&#44; aumentando a resili&#234;ncia e favorecendo a adapta&#231;&#227;o&#44; ou&#44; pelo contr&#225;rio&#44; dificultando o ajustamento e o bem-estar&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Popula&#231;&#227;o e m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Participaram neste estudo 74 pacientes com cardiopatias cong&#233;nitas&#44; tendo a recolha sido efetuada num &#250;nico momento temporal&#44; ou seja&#44; quando os pacientes se deslocavam ao hospital para a consulta de cardiologia pedi&#225;trica ou de cardiologia&#44; sendo abordados para participar no estudo&#46; Ap&#243;s terem sido informados de todos os aspetos inerentes ao estudo&#44; os pacientes que eram maiores de idade ou os cuidadores&#44; no caso de os pacientes serem menores de idade&#44; assinavam um termo de consentimento informado&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Dos 74 pacientes&#44; 41 eram do sexo masculino e 33 do sexo feminino&#46; A idade m&#233;dia dos participantes situou-se em torno dos 18&#44;76 anos &#40;&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;86&#41;&#44; com uma varia&#231;&#227;o de idades entre os 12-26 anos&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A gravidade da cardiopatia cong&#233;nita era complexa em 27 participantes&#44; moderada em 13 e menor em 34&#46; Relativamente &#224; severidade de les&#245;es residuais&#44; quatro apresentavam les&#245;es graves&#44; 18 moderadas e 52 leves&#46; Em rela&#231;&#227;o &#224; presen&#231;a de psicopatologia&#44; 17 participantes &#40;23&#37; do total&#41; 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sua hist&#243;ria cl&#237;nica&#44; como o diagn&#243;stico e a gravidade&#44; tipo de cardiopatia&#44; descri&#231;&#227;o das cirurgias realizadas&#44; les&#245;es residuais e a necessidade de terapia farmacol&#243;gica&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">A entrevista semiestruturada aplicada abordava &#225;reas como o suporte social&#44; o ambiente familiar&#44; as limita&#231;&#245;es funcionais&#44; o percurso escolar e o autoconceito&#46; Esta entrevista &#233; composta por 38 quest&#245;es&#44; variando entre op&#231;&#245;es de resposta m&#250;ltipla e resposta curta&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A entrevista psiqui&#225;trica estandardizada SADS-L foi aplicada no sentido de verificar a exist&#234;ncia de psicopatologia nos pacientes com cardiopatias cong&#233;nitas&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">O YSR e o ASR s&#227;o question&#225;rios de autorresposta que permitem fazer uma descri&#231;&#227;o do funcionamento da crian&#231;a ou do adulto&#46; Para efeitos deste estudo&#44; em rela&#231;&#227;o a estes instrumentos foram recolhidas as respostas das escalas do isolamento&#44; queixas som&#225;ticas&#44; ansiedade&#47;depress&#227;o&#44; altera&#231;&#245;es do pensamento&#44; problemas de aten&#231;&#227;o&#44; comportamento delinquente&#44; comportamento agressivo&#44; internaliza&#231;&#227;o e externaliza&#231;&#227;o&#46; Os resultados referentes &#224; escala de problemas sociais do YSR n&#227;o foram inclu&#237;dos&#44; uma vez que n&#227;o possu&#237;a uma escala equiparada no ASR<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">O CBCL e o ABCL s&#227;o question&#225;rios destinados a serem preenchidos pelos pais ou cuidadores &#40;algu&#233;m que os conhe&#231;a bem&#41;&#44; pois as respostas descrevem a perce&#231;&#227;o do funcionamento ou comportamento dos pacientes&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Os resultados do YSR e do ASR&#44; bem como os resultados do CBCL e do ABCL&#44; foram agrupados por serem instrumentos muito semelhantes e para permitir juntar um n&#250;mero maior de respostas&#44; com mais representatividade&#44; sendo que&#44; para efeitos de tratamento estat&#237;stico&#44; foram contabilizados os resultados totais de cada escala&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">O WHOQOL-Bref &#233; um question&#225;rio para a avalia&#231;&#227;o subjetiva da qualidade de vida&#44; que pode ser aplicado quer a indiv&#237;duos saud&#225;veis quer a doentes com qualquer tipo de patologia<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Este question&#225;rio &#233; composto por 26 quest&#245;es&#44; com resposta do tipo <span class="elsevierStyleItalic">likert</span>&#44; podendo a cada quest&#227;o ser atribu&#237;da uma classifica&#231;&#227;o entre 1-5&#46; O valor 5 corresponde ao valor mais elevado&#44; excetuando nas quest&#245;es tr&#234;s&#44; quatro e 26&#44; que est&#227;o formuladas negativamente e onde o valor 5 corresponde ao valor mais baixo&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Para a an&#225;lise dos dados foi utilizado o <span class="elsevierStyleItalic">software IBM Social Package for the Social Sciences</span> &#40;SPSS&#41;&#44; <span class="elsevierStyleItalic">version</span> 19&#46;0&#44; tendo sido usado o teste t de <span class="elsevierStyleItalic">student</span> para vari&#225;veis param&#233;tricas e o teste Mann-Whitney para as vari&#225;veis n&#227;o param&#233;tricas&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0120" class="elsevierStylePara elsevierViewall">Na <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a> encontram-se as diferen&#231;as no ajustamento psicossocial entre os dois g&#233;neros&#44; no autorrelato&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Na <a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a> figuram as diferen&#231;as no ajustamento psicossocial entre os participantes com formas graves de CC comparados com os que t&#234;m formas moderadas ou ligeiras&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Na <a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a> figuram as diferen&#231;as no ajustamento psicossocial entre participantes submetidos a interven&#231;&#227;o cir&#250;rgica&#44; quando comparados com os que n&#227;o necessitaram de cirurgia&#44; avaliados pelos cuidadores&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0020">Tabela 4</a> relata as diferen&#231;as do ajustamento psicossocial entre participantes com percurso escolar satisfat&#243;rio e os que tiveram um percurso mal sucedido&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0025">Tabela 5</a> apresenta os resultados da preval&#234;ncia de diagn&#243;stico psiqui&#225;trico dos nossos participantes comparativamente com os valores de refer&#234;ncia de outros estudos&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">&#201; de salientar que as participantes de sexo feminino apresentavam uma preval&#234;ncia de psicopatologia mais de duas vezes superior aos de sexo masculino &#40;33&#44;3 e 14&#44;6&#37;&#44; respetivamente&#44; sendo a diferen&#231;a estatisticamente significativa&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Na <a class="elsevierStyleCrossRef" href="#tbl0030">Tabela 6</a> constam os dados relativos &#224; caracteriza&#231;&#227;o da amostra em todos os dom&#237;nios da QV&#44; sendo comparados com os valores de refer&#234;ncia para a popula&#231;&#227;o portuguesa&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Na <a class="elsevierStyleCrossRef" href="#tbl0035">Tabela 7</a> figuram as diferen&#231;as da qualidade de vida obtidas pelos pacientes que foram submetidos a interven&#231;&#227;o cir&#250;rgica comparativamente com os que n&#227;o foram submetidos a cirurgia&#46;</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0040">Tabela 8</a> descreve as diferen&#231;as de qualidade de vida entre grupos com bom suporte social e com m&#225; qualidade de suporte&#46;</p><elsevierMultimedia ident="tbl0040"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">Na <a class="elsevierStyleCrossRef" href="#tbl0045">Tabela 9</a> encontram-se as diferen&#231;as relativas &#224; qualidade de vida&#44; entre participantes com percurso escolar satisfat&#243;rio e insatisfat&#243;rio&#46;</p><elsevierMultimedia ident="tbl0045"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">&#201; ainda importante referir que 51&#44;4&#37; dos participantes do nosso estudo tiveram reprova&#231;&#245;es na escola &#40;com m&#233;dia de 1&#44;74 anos<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#44;86&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discuss&#227;o</span><p id="par0175" class="elsevierStylePara elsevierViewall">Neste estudo&#44; os pacientes de sexo feminino apresentaram de forma estatisticamente significativa mais queixas som&#225;ticas&#44; maiores &#237;ndices de ansiedade e de depress&#227;o&#44; mais altera&#231;&#245;es do pensamento&#44; mais comportamentos agressivos&#44; bem como maior grau de internaliza&#231;&#227;o e&#44; portanto&#44; pior ajustamento psicossocial&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">As diferen&#231;as verificadas entre os sexos nos pacientes com cardiopatias cong&#233;nitas poder&#227;o estar relacionadas com a presen&#231;a de uma cicatriz localizada no peito&#44; resultante da interven&#231;&#227;o cir&#250;rgica&#44; podendo afetar a imagem corporal e a autoestima e revelar-se como um fator de inseguran&#231;a e de incerteza no relacionamento interpessoal e sexual&#46; Para al&#233;m da cicatriz&#44; outro aspeto que pode constituir-se como um fator de inseguran&#231;a para as pacientes com cardiopatias cong&#233;nitas reside na possibilidade da doen&#231;a card&#237;aca interferir na sua capacidade reprodutiva e com o parto<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6&#44;20</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">De salientar que os pacientes do sexo feminino tendem tamb&#233;m a apresentar &#237;ndices mais elevados de preocupa&#231;&#227;o nos aspetos relacionados com o seu corpo&#44; quando comparados com o sexo masculino<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Tamb&#233;m revelam uma tend&#234;ncia para apresentar n&#237;veis superiores de ansiedade&#47;depress&#227;o perante obst&#225;culos que interferem a n&#237;vel interpessoal&#44; o que se traduz em n&#237;veis superiores de internaliza&#231;&#227;o<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">As participantes do nosso estudo evidenciaram&#44; assim&#44; um risco superior para apresentar problemas emocionais e comportamentais&#44; quando comparadas com os participantes do sexo masculino<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Os pacientes com cardiopatias cong&#233;nitas complexas manifestavam em autorrelato mais queixas som&#225;ticas&#44; mais altera&#231;&#245;es do pensamento e tamb&#233;m &#237;ndices mais elevados de internaliza&#231;&#227;o&#44; quando comparados com os pacientes com cardiopatias cong&#233;nitas menores ou moderadas&#46; Os resultados obtidos parecem sugerir que os adolescentes e jovens adultos com cardiopatias cong&#233;nitas complexas apresentam pior ajustamento psicossocial&#44; podendo este facto estar associado &#224; necessidade de estes pacientes requererem mais cuidados a n&#237;vel m&#233;dico no decurso da sua vida&#44; enquanto os adolescentes e jovens adultos com cardiopatias cong&#233;nitas leves ou moderadas poder&#227;o manter uma vida di&#225;ria id&#234;ntica &#224; de outras pessoas da mesma idade consideradas saud&#225;veis<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;22</span></a>&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Tendo em considera&#231;&#227;o que as cardiopatias complexas apresentam um maior risco para os indiv&#237;duos&#44; quando comparadas com as cardiopatias menores ou moderadas&#44; &#233; compreens&#237;vel que os adolescentes e jovens adultos que t&#234;m uma forma complexa apresentem mais queixas som&#225;ticas&#44; estando estas associadas ao facto de os pacientes se encontrarem mais vigilantes para os sinais emitidos pelo seu corpo&#46; Estes sinais tendem a interferir com o seu pensamento&#44; tornando-se&#44; deste modo&#44; mais ansiosos relativamente a poss&#237;veis complica&#231;&#245;es que possam surgir &#40;a ansiedade &#233; uma das componentes da escala de internaliza&#231;&#227;o&#41;&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Quando avaliados pelos cuidadores&#44; os adolescentes e jovens adultos que n&#227;o tinham sido submetidos a interven&#231;&#245;es cir&#250;rgicas apresentavam mais queixas som&#225;ticas&#44; assim como altera&#231;&#245;es do pensamento comparativamente com os adolescentes e jovens adultos que foram sujeitos a interven&#231;&#245;es cir&#250;rgicas&#46; Os resultados obtidos no estudo revelam que as interven&#231;&#245;es cir&#250;rgicas exercem um papel preponderante para melhorar a qualidade de vida dos pacientes com cardiopatias cong&#233;nitas<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;23</span></a>&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">A doen&#231;a card&#237;aca cong&#233;nita implica um acompanhamento m&#233;dico regular&#44; sendo que&#44; por esta raz&#227;o&#44; muitos dos pacientes necessitam de faltar mais &#224; escola&#46; Este afastamento tem como consequ&#234;ncia a diminui&#231;&#227;o do rendimento acad&#233;mico&#44; ansiedade&#47;depress&#227;o&#44; problemas de aten&#231;&#227;o&#44; &#237;ndices superiores de internaliza&#231;&#227;o e de externaliza&#231;&#227;o&#44; sendo que estes aspetos corroboram os dados obtidos no estudo&#44; ou seja&#44; os pacientes que apresentavam um percurso escolar insatisfat&#243;rio apresentavam pior ajustamento psicossocial<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;23-26</span></a>&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">No que se refere &#224; morbilidade psiqui&#225;trica&#44; 23&#37; dos pacientes apresentavam diagn&#243;stico psiqui&#225;trico&#46; Tendo por base o valor de refer&#234;ncia de 10&#37; apresentado pela Organiza&#231;&#227;o Mundial de Sa&#250;de &#40;OMS&#41; para a popula&#231;&#227;o mundial saud&#225;vel&#44; os resultados sugerem que os adolescentes e jovens adultos com cardiopatias cong&#233;nitas poder&#227;o ter mais propens&#227;o para a psicopatologia<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Contudo&#44; quando comparada a nossa preval&#234;ncia &#40;23&#37;&#41; com os valores apontados por um estudo que re&#250;ne os dados de seis pa&#237;ses europeus &#40;25&#37;&#41; no que diz respeito &#224; presen&#231;a de algum tipo de perturba&#231;&#227;o mental&#44; pode constatar-se uma semelhan&#231;a nos resultados obtidos<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Num outro estudo foram tamb&#233;m encontrados resultados semelhantes de preval&#234;ncia de desordens mentais em Espanha &#40;19&#44;4&#37;&#41;&#44; It&#225;lia &#40;18&#44;1&#37;&#41; e Alemanha &#40;25&#44;2&#37;&#41;&#44; embora estes se contraponham aos n&#250;meros mais d&#237;spares para Fran&#231;a &#40;37&#44;9&#37;&#41; e Estados Unidos da Am&#233;rica &#40;47&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Seria&#44; por&#233;m&#44; pertinente e desej&#225;vel comparar a preval&#234;ncia de psicopatologia nos nossos doentes com valores obtidos para a popula&#231;&#227;o portuguesa&#44; o que n&#227;o &#233; poss&#237;vel por n&#227;o estarem ainda dispon&#237;veis&#44; sendo esta uma das limita&#231;&#245;es mais importantes do nosso estudo&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Comparando as participantes de sexo feminino com os de sexo masculino&#44; verificamos mais do dobro da preval&#234;ncia nas primeiras&#44; o que &#233; consistente com o pior ajustamento psicossocial tamb&#233;m verificado e com a preval&#234;ncia de psicopatologia &#40;sobretudo de tipo depressivo e ansioso&#41; reportadas em estudos populacionais de v&#225;rios pa&#237;ses&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Neste estudo&#44; foi poss&#237;vel verificar que a popula&#231;&#227;o de pacientes com cardiopatias cong&#233;nitas revelava uma melhor perce&#231;&#227;o da sua qualidade de vida&#44; comparativamente com os valores de refer&#234;ncia da popula&#231;&#227;o saud&#225;vel portuguesa nos dom&#237;nios das rela&#231;&#245;es sociais e ambiente&#46; Outros autores tamb&#233;m verificaram uma menor qualidade de vida comparativamente com a popula&#231;&#227;o normal&#44; sobretudo a n&#237;vel do dom&#237;nio f&#237;sico e no dom&#237;nio da qualidade de vida geral do WHOQOL-BREF&#44; enquanto tamb&#233;m se verificam diferen&#231;as nos dom&#237;nios psicol&#243;gico e social&#44; mas n&#227;o com uma diferen&#231;a t&#227;o expressiva<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Os indiv&#237;duos que n&#227;o foram submetidos a qualquer tipo de interven&#231;&#227;o cir&#250;rgica obtiveram melhor qualidade de vida ao n&#237;vel f&#237;sico&#44; de rela&#231;&#245;es sociais e geral&#44; na autoavalia&#231;&#227;o&#44; quando comparados com participantes sujeitos a cirurgia&#40;s&#41;&#46; Ainda que a grande parte dos pacientes com cardiopatias cong&#233;nitas sujeitos a corre&#231;&#245;es cir&#250;rgicas tendam a conseguir um funcionamento normal nos v&#225;rios vetores da sua vida&#44; s&#227;o colocados em jogo alguns desafios desenvolvimentais nos casos em que a cardiopatia tem uma gravidade complexa ou moderada&#44; o que dificulta o planeamento a longo prazo do futuro dos pacientes<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">O suporte social revelou uma grande influ&#234;ncia na qualidade de vida&#44; uma vez que os indiv&#237;duos com melhor suporte social apresentam melhor qualidade de vida em todos os dom&#237;nios avaliados&#44; mais concretamente f&#237;sico&#44; psicol&#243;gico&#44; rela&#231;&#245;es sociais&#44; ambiente e qualidade de vida geral&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">O suporte social&#44; seja a n&#237;vel individual&#44; da fam&#237;lia ou da comunidade &#233; um dos recursos prim&#225;rios com um efeito mais significativo&#44; mesmo como mediador de extrema import&#226;ncia entre <span class="elsevierStyleItalic">stress</span> e bem-estar psicol&#243;gico<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; &#201; tamb&#233;m importante destacar o papel atribu&#237;do ao suporte social&#44; uma vez que a perce&#231;&#227;o da disponibilidade de suporte social &#233; muito importante para diminuir os efeitos do <span class="elsevierStyleItalic">stress</span> a n&#237;vel dos problemas de sa&#250;de&#44; seja a n&#237;vel f&#237;sico ou psicol&#243;gico<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; Os indiv&#237;duos com um percurso escolar satisfat&#243;rio apresentam melhor qualidade de vida a n&#237;vel f&#237;sico&#44; ambiente e qualidade de vida geral&#44; al&#233;m de uma tend&#234;ncia para melhor qualidade de vida a n&#237;vel psicol&#243;gico&#46; O desempenho escolar pode ser altamente afetado pelas cardiopatias cong&#233;nitas&#44; j&#225; que a necessidade de hospitaliza&#231;&#245;es e de restri&#231;&#227;o das atividades com os colegas pode implicar afastamentos regulares da atividade escolar<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;29</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclus&#245;es</span><p id="par0260" class="elsevierStylePara elsevierViewall">Os resultados obtidos neste estudo parecem evidenciar que os adolescentes e jovens adultos com cardiopatias cong&#233;nitas apresentam uma predisposi&#231;&#227;o para apresentar problemas emocionais e comportamentais&#46; Entre eles&#44; os pacientes que parecem sofrer mais com os efeitos decorrentes do ajustamento psicossocial s&#227;o os pacientes do sexo feminino&#44; os pacientes com cardiopatias cong&#233;nitas complexas&#44; os pacientes que n&#227;o foram sujeitos a interven&#231;&#245;es cir&#250;rgicas &#40;opini&#227;o dos cuidadores&#41; e os pacientes com um percurso escolar insatisfat&#243;rio&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Os dados obtidos sobre morbilidade psiqui&#225;trica nesta popula&#231;&#227;o parecem indicar uma propens&#227;o ligeiramente mais alta para ser afetado por dist&#250;rbio psicopatol&#243;gico&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Al&#233;m disso&#44; os participantes deste estudo revelaram uma melhor qualidade de vida comparativamente &#224; popula&#231;&#227;o portuguesa&#44; tendo-se destacado o papel do suporte social&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">No entanto&#44; ainda que os v&#225;rios tipos de suporte social tenham um papel de destaque&#44; o facto de ser um tipo de doen&#231;a diagnosticada numa fase inicial da sua vida faz com que os pacientes tenham de p&#244;r em jogo todas as suas compet&#234;ncias para conseguirem fazer face &#224;s tarefas do desenvolvimento normativo e viver uma vida normal&#44; com algumas limita&#231;&#245;es que s&#227;o suplantadas com recurso &#224;s estrat&#233;gias de <span class="elsevierStyleItalic">coping</span> que elaboraram&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Financiamento</span><p id="par0280" class="elsevierStylePara elsevierViewall">Esta investiga&#231;&#227;o teve o financiamento da CESPU&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflito de interesses</span><p id="par0285" class="elsevierStylePara elsevierViewall">Esta investiga&#231;&#227;o teve o financiamento da CESPU&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Agradecimentos</span><p id="par0290" class="elsevierStylePara elsevierViewall">Esta investiga&#231;&#227;o teve o financiamento da CESPU&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Caracterizar a popula&#231;&#227;o de adolescentes e jovens adultos com cardiopatias cong&#233;nitas &#40;<span class="elsevierStyleSmallCaps">CC</span>&#41; ao n&#237;vel do seu ajustamento psicossocial e morbilidade psiqui&#225;trica&#44; bem como avaliar a qualidade de vida &#40;QV&#41;&#44; para perceber quais s&#227;o as vari&#225;veis com impacto na vida e na adapta&#231;&#227;o &#224; doen&#231;a&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Popula&#231;&#227;o e m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Participaram 74 pacientes com CC&#44; sendo 41 do sexo masculino e 33 do sexo feminino&#44; com idades entre 12-26 &#40;m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#44;76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;86&#41;&#46; Foram recolhidos os dados demogr&#225;ficos e cl&#237;nicos mais relevantes dos pacientes e foi aplicado um conjunto de instrumentos&#44; incluindo uma entrevista semiestruturada sobre t&#243;picos de suporte social&#44; estilo de educa&#231;&#227;o na fam&#237;lia&#44; autoimagem e limita&#231;&#245;es f&#237;sicas&#44; uma entrevista psiqui&#225;trica estandardizada e question&#225;rios para avaliar o ajustamento psicossocial na forma de autorrelato &#40;YSR e ASR&#41; e relato dos cuidadores &#40;CBCL e ABCL&#41;&#44; bem como um question&#225;rio de avalia&#231;&#227;o da qualidade de vida &#40;WHOQOL-BREF&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">O sexo feminino relatou mais ansiedade&#47;depress&#227;o &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>952&#44;500&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#44; altera&#231;&#245;es do pensamento &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>929&#44;500&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; e comportamento agressivo &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>999&#44;000&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41;&#46; Pacientes com CC complexas relataram mais altera&#231;&#245;es de pensamento &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>442&#44;000&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41; e internaliza&#231;&#227;o &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>429&#44;000&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;021&#41;&#46; Comparativamente com a popula&#231;&#227;o portuguesa&#44; os nossos participantes apresentaram melhor QV nos dom&#237;nios rela&#231;&#245;es sociais &#40;t<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;333&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;022&#41; e ambiente &#40;t<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;754&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41;&#46; Os pacientes que n&#227;o foram submetidos a interven&#231;&#245;es cir&#250;rgicas revelaram melhor QV nos dom&#237;nios f&#237;sico &#40;t<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;1&#44;989&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;050&#41;&#44; de rela&#231;&#245;es sociais &#40;t<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;2&#44;012&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;048&#41; e QV geral &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>563&#44;000&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;037&#41;&#46; A presen&#231;a de um melhor suporte social est&#225; relacionada com uma melhor QV nos pacientes em todos os dom&#237;nios avaliados&#44; com destaque para o f&#237;sico &#40;t<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;287&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; e rela&#231;&#245;es sociais &#40;t<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;669&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41;&#46; Um melhor desempenho acad&#233;mico encontrava-se tamb&#233;m associado com uma melhor perce&#231;&#227;o de QV global &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>457<span class="elsevierStyleHsp" style=""></span>000&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;046&#41;&#44; com menos tend&#234;ncia ao isolamento &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>812&#46;500&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;031&#41;&#44; menos sentimentos de ansiedade e de depress&#227;o &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>854<span class="elsevierStyleHsp" style=""></span>000&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&#44; menos problemas de aten&#231;&#227;o &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>903<span class="elsevierStyleHsp" style=""></span>500&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; e valores mais baixos de internaliza&#231;&#227;o &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>817<span class="elsevierStyleHsp" style=""></span>000&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;029&#41; e de externaliza&#231;&#227;o &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>803<span class="elsevierStyleHsp" style=""></span>500&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;042&#41;&#46; As limita&#231;&#245;es f&#237;sicas tinham um efeito nocivo no QV &#40;u<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>947<span class="elsevierStyleHsp" style=""></span>500&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Discuss&#227;o</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">As participantes do sexo feminino evidenciaram pior ajustamento psicossocial e maior propens&#227;o &#224; psicopatologia&#46; As CC complexas exigem mais cuidados regulares&#44; limitando o contacto social com pares&#44; a integra&#231;&#227;o escolar e de lazer&#44; e dificultando a adapta&#231;&#227;o&#46; A realiza&#231;&#227;o de cirurgias influencia a QV dos pacientes&#44; pela exig&#234;ncia de mais cuidados m&#233;dicos&#44; induzindo maiores limita&#231;&#245;es na sua vida di&#225;ria&#44; o que dificulta a aquisi&#231;&#227;o de uma rede de suporte social satisfat&#243;ria&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclus&#245;es</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Os pacientes com CC evidenciaram uma maior tend&#234;ncia a apresentar psicopatologia&#44; sendo o sexo feminino mais predisposto a sofrer com os efeitos do desajustamento psicossocial&#46; O suporte social revelou um papel preponderante no ajustamento dos doentes&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Objectives</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We aimed to study the psychosocial adjustment &#40;PSA&#41;&#44; psychiatric morbidity and quality of life of adolescents and young adults with congenital heart disease &#40;CHD&#41; to determine which demographic and clinical variables negatively affect adjustment and which increase resilience&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Methods</span><p id="spar0150" class="elsevierStyleSimplePara elsevierViewall">The study included 74 patients with CHD&#44; 41 male and 33 female&#44; aged between 12 and 26 years &#40;mean 18&#46;76&#177;3&#46;86&#41;&#46; Demographic information and a complete clinical history were obtained&#46; The participants were interviewed regarding social support&#44; family environment&#44; self-image and physical limitations&#46; A standardized psychiatric interview was conducted&#44; and self-report questionnaires were administered for assessment of PSA &#40;Youth Self Report and Adult Self Report&#41; and quality of life &#40;World Health Organization Quality of Life &#8211; Short Version&#41;&#46; A caregiver completed an observational version of the PSA questionnaire &#40;Child Behavior Checklist or Adult Behavior Checklist&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0155" class="elsevierStyleSimplePara elsevierViewall">Female participants showed more feelings of anxiety and depression &#40;U&#61;952&#46;500&#59; p&#61;0&#46;003&#41;&#44; thought problems &#40;U&#61;929&#46;500&#59; p&#61;0&#46;005&#41; and aggressive behavior &#40;U&#61;999&#46;000&#59; p&#61;0&#46;000&#41;&#46; They also showed a higher rate of psychopathology&#46; Patients with complex forms of CHD reported more thought problems &#40;U&#61;442&#46;000&#59; p&#61;0&#46;027&#41; and internalization &#40;U&#61;429&#46;000&#59; p&#61;0&#46;021&#41;&#46; Compared to the Portuguese population as a whole&#44; participants showed better quality of life in the domains of social relationships &#40;t&#61;2&#46;333&#59; p&#61;0&#46;022&#41; and environment &#40;t&#61;3&#46;754&#59; p&#61;0&#46;000&#41;&#46; Patients who had undergone surgery had worse quality of life in physical terms &#40;t&#61;-1&#46;989&#59; p&#61;0&#46;050&#41;&#44; social relationships &#40;t&#61;-2&#46;012&#59; p&#61;0&#46;048&#41; and general quality of life &#40;U&#61;563&#46;000&#59; p&#61;0&#46;037&#41;&#44; compared to those who were not operated&#46; Better social support was associated with better quality of life in physical terms &#40;t&#61;3&#46;287&#59; p&#61;0&#46;002&#41; and social relationships &#40;t&#61;3&#46;669&#59; p&#61;0&#46;000&#41;&#46; Better school performance was also associated with better overall quality of life &#40;U&#61;457&#46;000&#59; p&#61;0&#46;046&#41;&#44; less withdrawn behavior &#40;U&#61;812&#46;500&#59; p&#61;0&#46;031&#41;&#44; fewer feelings of anxiety and depression &#40;U&#61;854&#46;000&#59; p&#61;0&#46;009&#41;&#44; fewer attention problems &#40;U&#61;903&#46;500&#59; p&#61;0&#46;001&#41;&#44; and lower scores for internalization &#40;U&#61;817&#46;000&#59; p&#61;0&#46;029&#41; and externalization &#40;U&#61;803&#46;500&#59; p&#61;0&#46;042&#41;&#46; Physical limitations had a detrimental effect on quality of life &#40;U&#61;947&#46;500&#59; p&#61;0&#46;001&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="spar0160" class="elsevierStyleSimplePara elsevierViewall">Female participants were more prone to worse psychological adjustment and to psychopathology&#46; Patients with complex forms of CHD showed worse PSA&#44; as they need regular care&#44; which restricts social contact with peers and family and integration in school and leisure activities&#46; Patients who had undergone surgery showed worse quality of life as they often have long hospital stays&#44; during which social activities are restricted&#44; making it more difficult for them to develop a good social support network&#46; They require close medical care&#44; and the restrictions on their activities may be life-limiting&#46; Their sense of survival may also be threatened&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0165" class="elsevierStyleSimplePara elsevierViewall">Patients with CHD appear to be more prone to psychopathology and female patients are more likely to show worse PSA&#46; Social support was shown to play a crucial role in buffering stress and promoting patients&#8217; adjustment&#46;</p>"
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          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Teste de Mann-Whitney para as diferen&#231;as nas dimens&#245;es do ajustamento psicossocial de acordo com a gravidade da cardiopatia cong&#233;nita&#44; no autorrelato</p>"
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Percentagem da popula&#231;&#227;o adulta mundial com desordens mentais e comportamentais&#44; definida pela Organiza&#231;&#227;o Mundial de Sa&#250;de &#40;OMS&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Percentagem de popula&#231;&#227;o com algum tipo de perturba&#231;&#227;o mental&#44; de acordo com os dados do projeto ESEMeD em seis pa&#237;ses Europeus&#46;</p> <p class="elsevierStyleNotepara" id="npar0015"><span class="elsevierStyleSup">c&#44;d&#44;e&#44;f&#44;g</span> Percentagem da popula&#231;&#227;o com algum tipo de perturba&#231;&#227;o nos pa&#237;ses Espanha&#44; Fran&#231;a&#44; It&#225;lia&#44; Alemanha e Estados Unidos da Am&#233;rica&#44; respetivamente&#46;</p>"
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          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Preval&#234;ncia de diagn&#243;stico psiqui&#225;trico nos participantes do nosso estudo comparativamente com os valores de refer&#234;ncia para diversas popula&#231;&#245;es</p>"
        ]
      ]
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          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">A&#58; dom&#237;nio ambiente da QV&#59; DP&#58; desvio padr&#227;o&#59; F&#58; dom&#237;nio f&#237;sico da QV&#59; G&#58; QV geral&#59; M&#58; m&#233;dia&#59; p&#58; n&#237;vel de signific&#226;ncia&#59; P&#58; dom&#237;nio psicol&#243;gico da QV&#59; PE&#58; popula&#231;&#227;o do estudo&#59; RS&#58; dom&#237;nio rela&#231;&#245;es sociais da QV&#59; t&#58; t de Student&#59; VR&#58; valores de refer&#234;ncia para a popula&#231;&#227;o saud&#225;vel portuguesa&#46;</p><p id="spar0200" class="elsevierStyleSimplePara elsevierViewall">Negritos&#58; valores com signific&#226;ncia estat&#237;stica&#46;</p>"
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          "pt" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">M&#233;dia e desvio padr&#227;o para os quatro dom&#237;nios da QV e QV geral&#44; nos nossos participantes&#44; e valores de refer&#234;ncia na popula&#231;&#227;o portuguesa</p>"
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          "leyenda" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">A&#58; dom&#237;nio ambiente da QV&#59; C&#47;I&#58; com interven&#231;&#227;o&#59; DP&#58; desvio padr&#227;o&#59; F&#58; dom&#237;nio f&#237;sico da QV&#59; G&#58; QV geral&#59; M&#58; m&#233;dia&#59; p&#58; n&#237;vel de signific&#226;ncia&#59; P&#58; dom&#237;nio psicol&#243;gico da QV&#59; RS&#58; dom&#237;nio rela&#231;&#245;es sociais da QV&#59; S&#47;<span class="elsevierStyleSmallCaps">I</span>&#58; sem interven&#231;&#227;o&#59; t&#58; t de Student&#59; u&#58; u de Mann-Whitney&#46;</p><p id="spar0210" class="elsevierStyleSimplePara elsevierViewall">Negritos&#58; valores com signific&#226;ncia estat&#237;stica&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">S&#47;<span class="elsevierStyleSmallCaps">I</span> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41;</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">t&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">15&#44;81</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">17&#44;06</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">1&#44;567</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#8722;1&#44;989</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;525&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#44;443&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;153&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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          "pt" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Teste T de Student para os quatro dom&#237;nios da QV e teste de Mann-Whitney para a QV Geral&#44; comparando doentes que foram submetidos a cirurgia com os que n&#227;o tiveram interven&#231;&#245;es</p>"
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          "leyenda" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">A&#58; dom&#237;nio ambiente da QV&#59; DP&#58; desvio padr&#227;o&#59; F&#58; dom&#237;nio f&#237;sico da QV&#59; G&#58; QV geral&#59; M&#58; m&#233;dia&#59; MSS&#58; melhor suporte social&#59; p&#58; n&#237;vel de signific&#226;ncia&#59; P&#58; dom&#237;nio psicol&#243;gico da QV&#59; PSS&#58; pior suporte social&#59; RS&#58; dom&#237;nio rela&#231;&#245;es sociais da QV&#59; t&#58; t de Student&#59; u&#58; u de Mann-Whitney&#46;</p><p id="spar0220" class="elsevierStyleSimplePara elsevierViewall">Negritos&#58; valores com signific&#226;ncia estat&#237;stica&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">DP&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Teste T de Student para os quatro dom&#237;nios da QV e teste de Mann-Whitney para a QV Geral&#44; comparando os participantes com bom suporte social com os que tinham suporte insuficiente</p>"
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          "leyenda" => "<p id="spar0145" class="elsevierStyleSimplePara elsevierViewall">A&#58; dom&#237;nio ambiente da QV&#59; DP&#58; desvio padr&#227;o&#59; F&#58; dom&#237;nio f&#237;sico da QV&#59; G&#58; QV geral&#59; M&#58; m&#233;dia&#59; p&#58; n&#237;vel de signific&#226;ncia&#59; P&#58; dom&#237;nio psicol&#243;gico da QV&#59; PES&#58; percurso escolar satisfat&#243;rio&#59; PEI&#58; percurso escolar insatisfat&#243;rio&#59; RS&#58; Dom&#237;nio Rela&#231;&#245;es Sociais da QV&#59; t&#58; t de Student&#59; u&#58; u de Mann-Whitney&#46;</p><p id="spar0230" class="elsevierStyleSimplePara elsevierViewall">Negritos&#58; valores com signific&#226;ncia estat&#237;stica&#46;</p>"
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Informação do artigo
ISSN: 08702551
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2018 Julho 41 11 52
2018 Junho 49 8 57
2018 Maio 52 5 57
2018 Abril 49 7 56
2018 Maro 87 9 96
2018 Fevereiro 62 10 72
2018 Janeiro 53 7 60
2017 Dezembro 45 15 60
2017 Novembro 47 16 63
2017 Outubro 37 11 48
2017 Setembro 33 8 41
2017 Agosto 41 12 53
2017 Julho 29 9 38
2017 Junho 37 14 51
2017 Maio 49 16 65
2017 Abril 66 5 71
2017 Maro 45 35 80
2017 Fevereiro 66 7 73
2017 Janeiro 56 8 64
2016 Dezembro 41 7 48
2016 Novembro 22 7 29
2016 Outubro 31 4 35
2016 Setembro 42 10 52
2016 Agosto 14 5 19
2016 Julho 17 9 26
2016 Junho 1 0 1
2016 Maio 4 0 4
2016 Abril 19 2 21
2016 Maro 42 20 62
2016 Fevereiro 61 29 90
2016 Janeiro 56 16 72
2015 Dezembro 49 15 64
2015 Novembro 31 13 44
2015 Outubro 54 17 71
2015 Setembro 46 10 56
2015 Agosto 43 15 58
2015 Julho 45 12 57
2015 Junho 30 12 42
2015 Maio 40 7 47
2015 Abril 44 18 62
2015 Maro 36 15 51
2015 Fevereiro 31 9 40
2015 Janeiro 33 7 40
2014 Dezembro 27 17 44
2014 Novembro 20 10 30
2014 Outubro 44 14 58
2014 Setembro 38 22 60
2014 Agosto 34 20 54
2014 Julho 55 13 68
2014 Junho 41 14 55
2014 Maio 58 20 78
2014 Abril 47 14 61
2014 Maro 64 24 88
2014 Fevereiro 61 20 81
2014 Janeiro 77 38 115
2013 Dezembro 67 21 88
2013 Novembro 95 32 127
2013 Outubro 91 54 145
2013 Setembro 9 5 14
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