The mental health of Brazilian healthcare professionals during the COVID-19 pandemic: a longitudinal study

Objective: To compare the distress level among Brazilian healthcare professionals during the coronavirus disease 2019 (COVID-19) pandemic and estimate risks by sex, age, and occupation. Methods: In a longitudinal cohort design, a nationally distributed online survey was used to collect data from 10,490 active healthcare professionals who worked during the pandemic. Participants were mostly female, aged 18 to 82 years; 13 different health professions and all states of Brazil were represented. Results: The most frequent professions were psychology, dentistry, and nursing. The Brief Symptom Inventory (BSI) score suggested an increased distress perception among health professionals. Females showed poorer mental health than males, but the absolute rise in Global Severity Index (GSI) score was larger in males than in females. Younger adults reported more symptoms of psychological distress than older adults. The most impacted age group was between 30-39 years. Nurse technicians presented the highest risk of distress. Conclusion: Health professionals are essential to overcoming the pandemic; thus, their mental health status should be monitored, and features associated with increased distress should be identified. Our findings suggest distress risk should be stratified by occupation, age, and sex. Health professionals showed an increased distress perception. Women, individuals between the ages of 30 and 39, nursing personnel, and physicians were more likely to report distress compared with other health professionals.

Preditores de sofrimento psicológico e prevalência de transtornos mentais autodeclarados em profissionais de saúde e na população em geral durante a pandemia de Covid-19 no Brasil / Predictors of psychological distress and prevalence of self-reported mental disorders in health care professionals and in the general population during the Covid-19 pandemic in Brazil

O fardo dos transtornos mentais pode aumentar durante a pandemia de Covid-19. Por isso, é estratégico caracterizar a saúde mental da população. Analisamos dados coletados pela Internet de 164.881 profissionais de saúde e 5.635 participantes da população geral. O Índice de Gravidade Global (GSI) do Inventário Breve de Sintomas, diagnóstico autodeclarado de transtornos mentais, características sociodemográficas, estado de saúde física, história de contato com a Covid-19, percepções e preocupações e medidas preventivas adotadas foram comparados entre as amostras. Análises de regressão múltipla foram usadas para investigação de fatores associados ao GSI. O distresse psicológico foi classificado como alto ou muito alto em 13,4% dos profissionais de saúde e em 31,4% dos participantes da população geral. A prevalência de transtornos mentais ao longo da vida foi 36% para profissionais de saúde e 44,7% para a população geral, sendo os mais frequentes transtornos depressivos e ansiedade generalizada. Entre os profissionais de saúde, ser do sexo feminino e mais jovem foi associado à maior distresse psicológico. Para a população geral foram preditores de distresse a classe econômica e um domicílio com mais pessoas. Foram significativamente associados ao GSI sintomas de Covid-19, sentir-se menos produtivo no trabalho, medo de transmitir o vírus para a família, medo de dificuldades financeiras e sentir que os relacionamentos em casa pioraram. A prevalência de transtornos mentais atinge parte relevante da população brasileira. Fatores sociodemográficos, aspectos familiares e instabilidade financeira devem ser considerados no entendimento do distresse psicológico durante a pandemia.(AU)

BACKGROUND: The burden of mental disorders is likely to increase during the Covid-19 pandemic. Knowing the rate of psychological distress and mental disorders, its severity, and factors associated with psychological distress is strategical. METHOD: We analyzed online cross-sectional data from 164,881 health professionals and from 5,635 participants from the general population in Brazil. The Global Severity Index (GSI) from the Brief Symptom Inventory, self-reported diagnosis of mental disorders, sociodemographic characteristics, and factors related to Covid-19, such as physical health status, diagnosis and contact history, perceptions and concerns, and precautionary measures were compared between samples. Multiple regression analysis was used to investigate factors related to GSI scores. RESULTS: Psychological distress was high or very high in 13.4% of health professionals and in 31.4% of the general population. Health professionals reported a lower rate of current or previous history of mental disorders (36%) than participants from the general population (44.7%). Age (younger) and gender (female) predicted higher psychological distress for health professionals and economic class (lower) and household size (more members) for the general population. People with higher GSI scores reported to have experienced more physical symptoms associated with Covid-19, feeling less productive at work, being afraid of transmitting the coronavirus to the family, fear of financial difficulties, and feeling that home relations were worse during the pandemic outbreak. CONCLUSIONS: Psychological distress at the first wave of Covid-19 was associated with sociodemographic features and an anxious perception of physical symptoms, virus transmission to loved ones, disruption of family relations, and financial situation.(AU)

INTRODUCCIÓN: Es probable que la carga de los trastornos mentales aumente durante la pandemia de Covid-19. Conocer la tasa de malestar psicológico y de los trastornos mentales, su gravedad y los factores asociados al malestar psicológico es estratégico. MÉTODO: Se analizaron datos transversales en línea de 164.881 profesionales de la salud y 5.635 participantes de la población general de Brasil. Se compararon entre las muestras el Índice de Gravedad Global (GSI) del Inventario Breve de Síntomas, el diagnóstico auto declarado de trastornos mentales, las características sociodemográficas y los factores relacionados con la Covid-19. Se utilizó un análisis de regresión múltiple para investigar los factores relacionados con las puntuaciones del GSI. RESULTADOS: El malestar psicológico era alto o muy alto en 13,4% de los profesionales de la salud y en 31,4% de la población general. Los profesionales de la salud declararon tasa de 36% de trastornos mentales y la población general de 44,7%. La edad (más joven) y el sexo (femenino) predijeron un mayor malestar psicológico para los profesionales de la salud y la clase económica (más baja) y el tamaño de la familia (más miembros) para la población general. Las personas con puntuaciones más altas en el GSI declararon haber experimentado más síntomas físicos asociados a la Covid-19, sentirse menos productivos en el trabajo, tener miedo de transmitir el coronavirus a la familia, temer dificultades económicas y sentir que las relaciones domésticas empeoraron. CONCLUSIONES: La angustia psicológica se asoció a las características sociodemográficas y a la percepción ansiosa de los síntomas físicos, la transmisión del virus a los seres queridos, la perturbación de las relaciones familiares y la situación económica.(AU)

Translation, cultural adaptation, and content validity index of the Juvenile Love Scale to the Brazilian context

Abstract Background Passionate love involves physiological, emotional, and cognitive features that greatly changes behavior. This phenomenon seems universal or near universal. Even other animal species choose partners. An intense state of passionate love is associated with activity in dopamine pathways of the brain 'reward system', and recently has been regarded as a 'natural addiction'. Instruments or tools to evaluate romantic love during childhood is still scarce. Objective To perform the translation and cultural adaptation of the Juvenile Love Scale (JLS) for use in the Brazilian context targeted for adolescents between 14 and 18 years old. Methods The translation and cultural adaptation of JLS followed international recommendations, and its content validity was analyzed by a panel of experts in different areas of knowledge. Results The final version of the JLS for use in the Brazilian context showed high content validity (> 90%). Discussion To our knowledge, this is the first scale for measuring romantic or passionate love in adolescents adapted to the Brazilian context. This instrument is a significant contribution to the study of the dimensions of love, as well as to understand the impact of love on the psychiatric phenomena that pervade life in this stage of development.

Ecological validity of the five digit test and the oral trails test / Validade ecológica do teste dos cinco dígitos e do oral trails test

ABSTRACT Tests evaluating the attentional-executive system are widely used in clinical practice. However, proximity of an objective cognitive test with real-world situations (ecological validity) is not frequently investigated. The present study evaluate the association between measures of the Five Digit Test (FDT) and the Oral Trails Test (OTT) with self-reported cognitive failures in everyday life as measured by the Cognitive Failures Questionnaire (CFQ). Brazilian adults from 18-to-65 years old voluntarily performed the FDT and OTT tests and reported the frequency of cognitive failures in their everyday life through the CFQ. After controlling for the age effect, the measures of controlled attentional processes were associated with cognitive failures, yet the cognitive flexibility of both FDT and OTT accounted for by the majority of variance in most aspects of the CFQ factors. The FDT and the OTT measures were predictive of real-world problems such as cognitive failures in everyday activities/situations.

RESUMO Testes que avaliam o sistema atencional-executivo são amplamente adotados no contexto clínico. Contudo, a proximidade de uma medida cognitiva objetiva com situações reais (validade ecológica) são pouco investigadas. O presente estudo objetiva avaliar a associação entre o Teste dos Cinco Dígitos (FDT) e o Oral Trails Test (OTT) com falhas cognitivas do dia a dia relatadas no Questionário de Falhas Cognitivas (CFQ). Sessenta adultos brasileiros, de 18 a 65 e cinco anos, realizaram o FDT e o OTT e reportaram a frequência das falhas cognitivas por meio do CFQ. Controlando o efeito da idade, as medidas de processos atencionais controlados foram associadas com as falhas cognitivas, sendo que o componente de flexibilidade cognitiva do FDT e do OTT explicou a maior parte da variância das falhas. O FDT e o OTT foram preditores de problemas reais do dia a dia, como as falhas cognitivas.

Use of a modified version of the switching verbal fluency test for the assessment of cognitive flexibility / Uso de uma versão modificada da fluência verbal alternada para a avaliação da flexibilidade cognitiva

Objective:Verbal fluency tests are widely used for the assessment of executive functions. However, traditional versions of the test depend on several cognitive factors beyond these components. The aim of this study was to evaluate the associations of a modified version of the verbal fluency with specific measures of executive functions.Methods:Sixty adults were evaluated using traditional versions of verbal fluency (animals/fruits) and a modified condition where subjects must switch between animals and fruits. Processing speed, semantic abilities, psychiatric symptoms and executive functions were also assessed.Results:Partial correlations between the verbal fluency tests and measures of executive functions, controlled for demographic, cognitive and psychiatric symptoms, suggest that cognitive flexibility has 9% shared variance with the verbal fluency test - category animals, 2 % with category fruits, 8% with total words in switching condition, and 20% with total correct word-pairs produced in switching condition. The other aspects of executive functions during the task had shared variance of between 1% and 7% with the verbal fluency tasks.Conclusion:The results suggest that correct word-pairs produced in switching verbal fluency may be a more specific measure for evaluating cognitive flexibility compared to other versions of verbal fluency.

Objetivo:Os testes de fluência verbal são comumente adotados para a avaliação cognitiva de pacientes com transtornos mentais ou doenças neurológicas. Embora muitas vezes utilizado na avaliação das funções executivas, sobretudo flexibilidade cognitiva, versões tradicionais do teste dependem de diversos fatores cognitivos além desses componentes. O objetivo do presente estudo é avaliar as associações de uma versão adaptada do teste de fluência verbal com medidas específicas de funções executivas.Métodos:Avaliamos sessenta adultos com versões tradicionais da fluência verbal (animais/frutas) e uma condição modificada onde o sujeito deve alternar entre animais e frutas. Avaliamos também a velocidade de processamento, habilidades semânticas, sintomas psiquiátricos e aos três componentes centrais das funções executivas (controle inibitório, memória de trabalho e flexibilidade cognitiva).Resultados:As correlações parciais entre os testes de fluência verbal e as medidas de funções executivas, controladas por fatores demográficos, cognitivos e pelos sintomas psiquiátricos, sugere que a flexibilidade cognitiva apresenta 9% de variância compartilhada com o teste de fluência verbal categoria animais, 2% com a categoria frutas, 8% com o total de palavras na fluência verbal alternada, e 20% com total de pares corretos produzidos na fluência verbal alternada. Os demais aspectos das funções executivas durante a tarefa apresentaram variância compartilhada entre 1% e 7% com as tarefas de fluência verbal.Conclusão:Os dados sugerem que o total de pares produzidos no teste de fluência verbal alternada pode ser uma medida mais especifica para a avaliação da flexibilidade cognitiva quando comparado a outras versões da fluência verbal.

Neurofibromatosis: part 2 – clinical management / Neurofibromatoses: parte 2 – manejo clínico

Part 1 of this guideline addressed the differential diagnosis of the neurofibromatoses (NF): neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2) and schwannomatosis (SCH). NF shares some features such as the genetic origin of the neural tumors and cutaneous manifestations, and affects nearly 80 thousand Brazilians. Increasing scientific knowledge on NF has allowed better clinical management and reduced rate of complications and morbidity, resulting in higher quality of life for NF patients. Most medical doctors are able to perform NF diagnosis, but the wide range of clinical manifestations and the inability to predict the onset or severity of new features, consequences, or complications make NF management a real clinical challenge, requiring the support of different specialists for proper treatment and genetic counseling, especially in NF2 and SCH. The present text suggests guidelines for the clinical management of NF, with emphasis on NF1.

A primeira parte desta diretriz abordou o diagnóstico diferencial das neurofibromatoses (NF): neurofibromatose do tipo 1 (NF1), neurofibromatose do tipo 2 (NF2) e schwannomatose (SCH). As NF compartilham algumas características, como a origem neural dos tumores e sinais cutâneos, e afetam cerca de 80 mil brasileiros. O aumento do conhecimento científico sobre as NF tem permitido melhor manejo clínico e redução da morbidade das complicações, resultando em melhor qualidade de vida para os pacientes com NF. A maioria dos médicos é capaz de realizar o diagnóstico das NF, mas a variedade de manifestações clínicas e a dificuldade de se prever o surgimento e a gravidade de complicações, torna o manejo da NF um desafio para o clínico e envolve diferentes especialistas para o tratamento adequado e aconselhamento genético, especialmente a NF2 e a SCH. O presente texto sugere algumas orientações para o acompanhamento dos portadores de NF, com ênfase na NF1.

Síndrome metabólica em adultos: prevalência e concordância entre critérios diagnósticos / Metabolic syndrome in adults: prevalence and concordance between criteria diagnoses

Introdução: A síndrome metabólica (SM) é caracterizada poralterações fisiopatológicas que aumentam o risco de doenças cardiovasculares.Objetivo: Avaliar a frequência de síndrome metabólicaem adultos de acordo com critérios diagnósticos e analisar qualparâmetro a identificou melhor. Método: Estudo de 124 pacientesdo ambulatório de nutrição clínica de um Instituto de Cardiologia deSão Paulo. O diagnóstico de síndrome metabólica foi determinadode acordo com os critérios do National Cholesterol Education Program- Adult Treatment Panel III (NCEP/ATPIII) e da InternationalDiabetes Federation (IDF) para todos os pacientes. Utilizou-se testequi-quadrado para análise das diferenças entre as variáveis categóricas.A média das variáveis numéricas foi comparada por teste deMann Whitney para amostras independentes com nível de significânciade 0,05 ou 5%. Para testar a concordância entre os critérios,utilizou-se o coeficiente Kappa. Resultados: Participaram do estudo61 homens e 63 mulheres. O grupo apresentou percentuais elevadosde pré-obesidade (31,5%), obesidade (64,5%) e alterações do perfilglicídico (62,9%). Diferenças estatísticas significantes entre os sexosforam encontradas nas frequências de hipertensão arterial (p = 0,01)e circunferência elevada (p = 0,00). A concordância geral entre oscritérios foi muito boa (Kappa = 0,897; p = 0,000). Observou-seque 92,6% dos pacientes que foram diagnosticados com SM peloATPIII também o foram pela IDF. Conclusão: A concordância entreos critérios para diagnósticos da SM indicou que ambos podem serutilizados na prática clínica.

Introduction: Metabolic Syndrome (MS) is characterized by pathophysiologicalchanges that increase the risk of cardiovascular disease.Objective: To evaluate the frequency of metabolic syndrome inadults according to criteria diagnoses and analyze which parameterbest identified it. Method: The study of 124 patients from the ClinicalNutrition Institute of Cardiology in São Paulo. The diagnosis ofmetabolic syndrome was determined according to the criteria of theNational Cholesterol Education Program - Adult Treatment Panel III(NCEP/ATPIII) and International Diabetes Federation (IDF) for allpatients. The chi-square analysis of differences between categoricalvariables was used. The average numerical variables were comparedby Mann-Whitney test for independent samples with significancelevel of 0.05 or 5%. The Kappa coefficient was used to evaluate theconcordance between both criteria. Results: The study included 61men and 63 women. The group had high percentages of pre-obesity(31.5%), obesity (64.5%) and abnormal glucose profile (62.9%).Statistically significant differences between sexes were found inthe frequencies of hypertension (p = 0.01) and high circumference(p = 0.00). The overall agreement between the criteria was verygood (Kappa = 0.897, p = 0.000). It was observed that 92.6% ofpatients who were diagnosed with MS by ATPIII were also by IDF.Conclusion: The agreement between the criteria for diagnosis ofMS indicated that both can be used in clinical practice.