Delirium severity and outcomes of critically ill COVID-19 patients / Gravidade do delirium e desfechos de pacientes críticos com COVID-19

ABSTRACT Objective: To investigate the impact of delirium severity in critically ill COVID-19 patients and its association with outcomes. Methods: This prospective cohort study was performed in two tertiary intensive care units in Rio de Janeiro, Brazil. COVID-19 patients were evaluated daily during the first 7 days of intensive care unit stay using the Richmond Agitation Sedation Scale, Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and Confusion Method Assessment for Intensive Care Unit-7 (CAM-ICU-7). Delirium severity was correlated with outcomes and one-year mortality. Results: Among the 277 COVID-19 patients included, delirium occurred in 101 (36.5%) during the first 7 days of intensive care unit stay, and it was associated with a higher length of intensive care unit stay in days (IQR 13 [7 - 25] versus 6 [4 - 12]; p < 0.001), higher hospital mortality (25.74% versus 5.11%; p < 0.001) and additional higher one-year mortality (5.3% versus 0.6%, p < 0.001). Delirium was classified by CAM-ICU-7 in terms of severity, and higher scores were associated with higher in-hospital mortality (17.86% versus 34.38% versus 38.46%, 95%CI, p value < 0.001). Severe delirium was associated with a higher risk of progression to coma (OR 7.1; 95%CI 1.9 - 31.0; p = 0.005) and to mechanical ventilation (OR 11.09; 95%CI 2.8 - 58.5; p = 0.002) in the multivariate analysis, adjusted by severity and frailty. Conclusion: In patients admitted with COVID-19 in the intensive care unit, delirium was an independent risk factor for the worst prognosis, including mortality. The delirium severity assessed by the CAM-ICU-7 during the first week in the intensive care unit was associated with poor outcomes, including progression to coma and to mechanical ventilation.

RESUMO Objetivo: Investigar como a gravidade do delirium afeta pacientes graves com COVID-19 e sua associação com os desfechos. Métodos: Estudo de coorte prospectivo realizado em duas unidades de terapia intensiva terciárias no Rio de Janeiro (RJ). Os pacientes com COVID-19 foram avaliados diariamente durante os primeiros 7 dias de internação na unidade de terapia intensiva usando a escala de agitação e sedação de Richmond, a Confusion Assessment Method for Intensive Care Unit (CAM-ICU) e a Confusion Assessment Method for Intensive Care Unit-7 (CAM-ICU-7). A gravidade do delirium foi correlacionada com os desfechos e a mortalidade em 1 ano. Resultados: Entre os 277 pacientes com COVID-19 incluídos, o delirium ocorreu em 101 (36,5%) durante os primeiros 7 dias de internação na unidade de terapia intensiva e foi associado a maior tempo de internação na unidade de terapia intensiva em dias (IQ: 13 [7 - 25] versus 6 [4 - 12]; p < 0,001), maior mortalidade hospitalar (25,74% versus 5,11%; p < 0,001) e maior mortalidade em 1 ano (5,3% versus 0,6%, p < 0,001). O delirium foi classificado pela CAM-ICU-7 em termos de gravidade, e escores maiores foram associados à maior mortalidade hospitalar (17,86% versus 34,38% versus 38,46%, IC95%, valor de p < 0,001). O delirium grave foi associado a um risco maior de progressão ao coma (RC de 7,1; IC95% 1,9 - 31,0; p = 0,005) e à ventilação mecânica (RC de 11,09; IC95% 2,8 - 58,5; p = 0,002) na análise multivariada, ajustada por gravidade e fragilidade Conclusão: Em pacientes internados com COVID-19 na unidade de terapia intensiva, o delirium foi fator de risco independente para o pior prognóstico, incluindo mortalidade. A gravidade do delirium avaliada pela CAM-ICU-7 durante a primeira semana na unidade de terapia intensiva foi associada a desfechos desfavoráveis, incluindo a progressão ao coma e à ventilação mecânica.

Theoretical procedures of the cross-cultural adaptation process of the Child Mania Rating Scale - Parent Version (CMRS-P) for the Brazilian context

Abstract Objectives To describe the theoretical procedures employed in the process of cross-cultural adaptation (CCA) for Brazil of the Child Mania Rating Scale - Parent Version (CMRS-P). Methods Seven steps were carried out: (1) translations and synthesis; (2) Committee of Judges-I; (3) grammatical review; (4) Committee of Judges-II; (5) semantic analysis (pre-test); (6) back-translation; and (7) discussion with the authors of the original instrument. Participants were two professional translators, 14 experts, a grammar proofreader, and 21 parents/guardians, representatives of the target population. The results were analyzed in terms of the percentage of agreement between evaluators and the content validity coefficient (CVC) and by analysis of comments and suggestions. Results Grammatical and cultural adjustments were made, in addition to substitution and/or inclusion of words and examples. Adequacy agreement indexes exceeding 86% were achieved and the CVC result for the total scale was excellent (0.95). The pre-test indicated good acceptance and understanding by participants. Conclusion The proposed version proved to be promising for use in the Brazilian context, although further psychometric studies are still needed to prove the scale's validity and reliability.

Estudios psicométricos de los instrumentos en español para la detección de trastornos mentales comunes: una revisión / Psychometric studies of instruments in Spanish for the detection of common mental disorders: A review

RESUMEN El objetivo de esta revisión es describir las características psicométricas de las versiones en español de instrumentos utilizados en la detección de trastornos mentales comunes, sobre la base de una búsqueda sistemática en PubMed y Google Académico. Se identificaron los siguientes instrumentos con información pertinente: General Health Questionnaire (GHQ-12 y GHQ-28), Hospital Anxiety and Depression Scale (HADS), Escala de Salud Personal (ESP), Self-Reporting Questionnaire (SRQ-20), Escala de Malestar Psicológico de Kessler (K-6 y K-10), Patient Health Questionnaire (PHQ), Escala de Edimburgo (EPDS), Dep5, Anx5 y Symptom Checklist (SCL-90 y SCL-90-R). Los instrumentos más estudiados fueron el GHQ y la HADS. La mayoría de estudios fueron realizados en España. En Perú se evaluaron el SRQ-20, la ESP, la K-6, la K-10 y el GHQ-28. Las propiedades psicométricas descritas incluyen: consistencia interna, estructura factorial, área bajo la curva Receiver Operating Characteristic (abcROC), sensibilidad, especificidad e índice de Youden (J). El J de los instrumentos estudiados estuvo entre 0,2389 y 0,767 y el abcROC, entre 0,758 y 0,933. Esta revisión puede asistir en la elección de instrumentos psicométricos en español para la realización de estudios y la práctica clínica, así como en la identificación de necesidades de investigación sistemática en torno al tema.

SUMMARY The objective of this review is to describe the psychometric characteristics of the Spanish versions of instruments for the detection of common mental disorders, on the basis of a systematic search carried out in PubMed and Google Scholar. The following instruments with pertinent psychometric information were identified: General Health Questionnaire (GHQ-12 and GHQ-28), Hospital Anxiety and Depression Scale (HADS), Personal Health Scale (PHS), Self-Reporting Questionnaire (SRQ -20), Kessler Psychological Distress Scale (K-6 and K-10), Patient Health Questionnaire (PHQ), Edinburgh Scale (EPDS), Dep5, Anx5 and Symptom Checklist (SCL-90 and SCL-90-R). The most studied instruments were GHQ and HADS. Most of the studies were carried out in Spain. In Peru, SRQ-20, PHS, K-6, K-10 and GHQ-28 were evaluated. The psychometric properties described include internal consistency, factorial structure, area under the Receiver Operating Characteristic curve (AUC), sensitivity, specificity and Youden index (J). J of the instruments were between 0.2389 and 0.767, and the AUC, between 0.758 and 0.933. This review could help to choose psychometric instruments in Spanish for studies and clinical practice, as well as to systematically identify research needs about this topic.

Cross-cultural adaptation and psychometric evaluation of the Brazilian version of the Temporal Experience of Pleasure Scale (TEPS-Br)

Abstract Introduction: Anhedonia is a critical symptom of major depressive disorder that is defined as the reduced ability to experience pleasure. The Temporal Experience of Pleasure Scale (TEPS) is commonly used to measure anhedonia and has exhibited satisfactory reliability. Objectives: We aim to perform cross-cultural adaptation of a Brazilian version of the TEPS and evaluate its psychometric properties. Method: The cross-cultural adaptation was performed according to previously established protocols. Cronbach's alpha coefficient of internal consistency was used to establish the degree of interrelation and coherence of items. Also, we calculated the intraclass correlation coefficient to determine the stability of the scale after a proposed interval had elapsed and used exploratory factor analysis to evaluate the scale's factor structure and content validity. Principal component analysis was used to determine the factors to be retained in the factor model. Results: The participants reported that the Brazilian version of the TEPS had good comprehensibility and applicability. The results revealed a statistically significant correlation between measures. The intraclass correlation coefficient calculated was significant. The Cronbach's alpha value calculated indicated that the scale's overall internal consistency was adequate. Conclusion: The Portuguese version of the TEPS scale proposed achieved good comprehensibility for the Brazilian population and its psychometric characteristics demonstrated good reliability and validity.

Influencing factors for positive results in early postpartum depression screening / 中华围产医学杂志

Objective:To investigate the risk factors associated with the positive results of early postpartum depression screening.Methods:This study involved 2 889 women who were negative in prenatal depression screening and delivered in the Maternal and Child Health Hospital of Hubei Province from 1 March to 30 April 2021. The Edinburgh Postnatal Depression Scale (EPDS) score, Adaptation Partnership Growth Affection Resolve (APGAR) score, and related living habits of the enrolled subjects were investigated on the 5th to 7th day after delivery. All patients were divided into two groups with 2 354 in the negative group (EPDS score<13) and 535 in the positive group (EPDS score≥13), based on the EPDS scores at 5 to 7 days postpartum. Chi-square test, trend Chi-square test, and rank-sum test were used for univariate analysis. Risk factors associated with positive depression screening were analyzed using binary logistic regression. Results:Univariate analysis suggested that there were statistically significant differences between the two groups in maternal personality, marital relationship, family functioning, sleep quality during pregnancy, smoking and drinking habits during pregnancy, prenatal EPDS score, mode of delivery, whether or not to have intrapartum cesarean section and forceps delivery, duration of labor in vaginal delivery, the proportions of puerperae and neonates who were transferred to intensive care unit (ICU), twin pregnancy, placenta previa, abnormal fetal position, premature birth, postpartum hemorrhage, and having three or more complication (all P<0.05). Binary logistic regression analysis suggested that extravertion ( OR=0.483, 95% CI:0.369-0.632), good marital relations ( OR=0.540, 95% CI:0.422-0.691) and good sleep during pregnancy ( OR=0.340, 95% CI:0.245-0.471) were protective factors for early postpartum depression, while introversion ( OR=1.632, 95% CI:1.275-2.088), poor marital relations ( OR=3.495, 95% CI: 1.946-6.276), moderate family dysfuntion ( OR=4.038, 95% CI:2.667-6.114) and severe family dysfunction ( OR=20.234, 95% CI: 2.446-167.364), smoking ( OR=2.071, 95% CI:1.315-3.263) and drinking during pregnancy ( OR=1.924, 95% CI:1.142-3.243), twin pregnancy ( OR=2.680, 95% CI:1.435-5.005), placenta previa ( OR=2.567, 95% CI:1.316-5.009), having three or more complications ( OR=1.876, 95% CI: 1.316-2.674), forceps delivery ( OR=3.043, 95% CI:1.185-7.816), intrapartum cesarean section ( OR=1.917, 95% CI:1.232-2.982), postpartum hemorrhage ( OR=1.668, 95% CI:1.069-2.604), and postpartum ICU admission ( OR=2.601, 95% CI: 1.112-6.086) were risk factors for early postpartum depression. Conclusions:Healthy living habits, and good mood contribute to decreasing postpartum depression in pregnant women. Education for parturients with serious illness or complications should be strengthened to help develop a proper understanding of the disease.

Status quo of social support and social function in homeless schizophrenics / 中国基层医药

Objective:To investigate status quo of social support and social function in homeless schizophrenics.Methods:A total of 468 schizophrenics who received treatment in Hangzhou Seventh People's Hospital from January 2018 to December 2019 were included in this study. They were divided into homeless group ( n = 310) and non-homeless group ( n = 158) according to whether they had homeless behaviors. The basic information of admitted patients, level of social support and disease severity were surveyed among admitted patients using self-made questionnaire regarding basic information of admitted patients, Social Support Rating Scale, and Brief Psychiatric Rating Scale. Results:The numbers of schizophrenics in the aspects including male gender, rural household registration, non-local residents, no occupation, unmarried status, low level education, and age at 30-50 years in the homeless group were significantly higher than those in the non-homeless group ( χ2 = 3.58, 20.14, 18.69, 46.29, 33.16, 24.38, 29.75, all P < 0.05). The score for each SSRS domain and total score in the homeless group were significantly lower than those in the non-homeless group [(15.35 ± 5.42) points, (4.34 ± 2.78) points, (6.48 ± 1.89) points, (26.23 ± 7.35) points; (18.99 ± 3.78) points, (6.35 ± 3.23) points, (7.82 ± 2.01) points, (32.59 ± 7.02) points, t = 6.34, 10.52, 12.83, 14.68, all P < 0.001]. The score for each BPRS domain and total score in the homeless group were significantly higher than those in the non-homeless group [(19.35 ± 5.85) points, (22.58 ± 2.73) points, (18.74 ± 2.46) points, (18.48 ± 0.25) points, (16.38 ± 3.12) points, (79.43 ± 3.64) points; (12.92 ± 4.23) points, (16.24 ± 3.66) points, (16.97 ± 3.77) points, (10.58 ± 3.34) points, (6.36 ± 4.23) points, (62.72 ± 2.57) points, t = 9.92, 7.02, 6.33, 10.35, 15.74, 28.46, all P < 0.001]. Conclusion:The poor individual condition and low level of social support in patients with schizophrenia are important factors that cause homelessness.

Validación de constructo de la escala Zung en pacientes con falla cardíaca / Zung Scale Construct Validation in Heart Failure Patients / Validação do construto da escala de Zung em pacientes com insuciência cardíaca

Introducción: la escala Zung para depresión ha sido previamente utilizada en pacientes con falla cardíaca; sin embargo, en nuestro conocimiento no se encuentra evidencia de su validez para la versión en español, ni su uso en población adulta con falla cardíaca en Colombia. Objetivo: determinar la validez de constructo de la escala Zung para depresión en su versión original y proponer una versión abreviada para pacientes adultos con falla cardíaca. Método: estudio de corte transversal, realizado en 200 pacientes de una clínica de falla y trasplante cardiaco, a quienes se aplicó la Zung Self-Rating Depression Scale. Se evaluó la consistencia interna por medio del alfa de Cronbach, y el análisis factorial fue utilizado para identificar las dimensiones del instrumento. Resultados: la consistencia interna de la versión original de la escala (20 ítems) fue de α = 0,811. El análisis de factores mostró una estructura compuesta por tres de ellos que explican el 51,59 % de la varianza total. La nueva versión abreviada (13 ítems) obtuvo un α = 0,819, y los ítems correlacionaron con un único factor que explicó el 33,54 % de la varianza total. Discusión: Nuestros hallazgos son similares a los encontrados por otros autores en diferentes poblaciones a la estudiada. Conclusiones: se evidenció validez de constructo tanto para la escala Zung, para depresión, en su versión original, como para la abreviada, creada en la población estudiada. Sin embargo, se requieren estudios adicionales que verifiquen estos hallazgos en una muestra representativa, y que otros aspectos de la psicometría sean evaluados.

Introduction: the Zung scale for depression has previously been used in patients with heart failure; However, to our knowledge, there is no evidence of its validity for the Spanish version, nor its use in the adult population with heart failure in Colombia. Objective: to determine the construct validity of the Zung scale for depression in its original version and propose an abbreviated version for adult patients with heart failure. Method: A cross sectional study was carried out in 200 patients from a heart failure and transplant clinic to whom the Zung Self-Rating Depression Scale was applied. Internal consistency was evaluated using Cronbach's alpha, and factor analysis was used to identify the instrument's dimensions. Results: the internal consistency of the original version of the scale (20 items) was α = 0.811. The factor analysis showed a structure composed of three that explains 51.59% of the total variance. The new abbreviated version (13 items) obtained α = 0.819, and the items correlated with a single factor that explained 33.54% of the total variance. Discussion: Our findings are similar to those found by other authors in different populations from the one studied. Conclusions: construct validity was evidenced for both the Zung scale for depression, in its original version, and the abbreviated version created in the studied population.

Introdução: a escala de Zung para depressão foi usada anteriormente em pacientes com insuficiência cardíaca. No entanto, até onde sabemos, não há evidências de sua validade para a versão em espanhol, nem seu uso na população adulta com insuficiência cardíaca na Colômbia. Objetivo: determinar a validade de construto da escala de Zung para depressão em sua versão original e propor uma versão abreviada para pacientes adultos com insuficiência cardíaca. Método: estudo transversal, realizado com 200 pacientes de uma clínica de insuciência cardíaca e transplante, aos quais foi aplicada a Zung Self Rating Depression Scale. A consistência interna foi avaliada por meio do alfa de Cronbach e a análise fatorial foi utilizada para identificar as dimensões do instrumento. Resultados: a consistência interna da versão original da escala (20 itens) foi α = 0,811. A análise fatorial mostrou uma estrutura composta por três deles que explicam 51,59% da variância total. A nova versão abreviada (13 itens) obteve α = 0,819, e os itens se correlacionaram com um único fator que explicou 33,54% da variância total. Discussão: Nossos achados são semelhantes aos encontrados por outros autores em populações diferentes da estudada. Conclusões: a validade de construto foi evidenciada tanto para a escala de Zung, para depressão, em sua versão original, quanto para a versão abreviada, elaborada na população estudada. No entanto, estudos adicionais são necessários para verificar esses achados em uma amostra representativa e que forem avaliados outros aspectos da psicometria

Parent-teacher report reliability on the fourth edition of the Swanson, Nolan and Pelham scale in a Brazilian clinical sample of children and adolescents with attention-deficit/hyperactivity disorder

Abstract Background Parents and teachers can be valuable sources of information for characterizing children's ADHD-related impairments in different environments. However, evidence indicated that those categories of informants often provide conflicting responses in formal assessment scales, which may challenge diagnostic decisions regarding the condition. Objective: We aimed to investigate reliability rates between parents and teachers of children and adolescents with and without ADHD using SNAP IV. Methods 199 children and adolescents aged 6 to 17 years were evaluated for ADHD symptoms using parent-rated and teacher-rated SNAP IV scales. Intraclass correlation coefficients were analyzed for ADHD domains (inattention and hyperactivity/impulsivity), as well as for defiant-oppositional behavior. Results Reports from parents and teachers showed low reliability for all ADHD domains. Parents' scores on the SNAP IV were higher than those of teachers. Parents and teachers provided highly discrepant responses concerning to the presence and severity of ADHD in children and adolescents, which might result from intrinsic aspects related to their daily functioning in different settings. Discussion Clinicians should consider those trends in parental and teachers' responses when interpreting results from informant-based instruments for detecting ADHD.

Common mental disorders and perinatal depressive symptoms: an integrative review / Trastorno mental común y síntoma depresivo perinatal: revisión integrativa / Transtorno mental comum e sintoma depressivo perinatal: revisão integrativa

ABSTRACT Objective: to investigate occurrence and risk factors for common mental disorders and perinatal depressive symptoms. Methods: an integrative literature review using CINAHL, Embase, PubMed, PsycINFO, and LILACS, looking for studies conducted between 2014 and 2019. Data collection took place between June and July 2019. Health Sciences Descriptors (DeCS) and Medical Subject Heading (MeSH) were used in the search strategies employed in each database. Results: thirteen articles were included. Most studies were conducted in Brazil and with a cross-sectional design. The highest prevalence of common mental disorders (63%) and depressive symptoms (30%) were found in Brazilian studies. Conclusion: high frequencies were found for perinatal mental disorder, with emphasis on studies carried out in Brazil. Low socioeconomic status, being a single mother, history of mental disorder, unplanned pregnancy and multiparity were risk factors for the investigated disorders.

RESUMEN Objetivo: investigar la aparición y los factores de riesgo de trastorno mental común y síntoma depresivo perinatal. Métodos: revisión integral de la literatura, utilizando las bases de datos CINAHL, Embase, PubMed, PsycINFO y LILACS, buscando estudios realizados entre 2014 y 2019. La recopilación de datos se produjo entre junio y julio de 2019. Descriptores en Ciencia de Health (DeCS) y Medical Subject Heading (MeSH) en las estrategias de búsqueda utilizadas en cada base de datos. Resultados: se incluyeron 13 artículos. La mayoría de los estudios se realizaron en Brasil y con un diseño transversal. Las prevalencias más altas de trastorno mental común (63%) y síntomas depresivos (30%) se encontraron en estudios brasileños. Conclusión: se encontraron altas frecuencias para el trastorno mental perinatal, con énfasis en estudios realizados en Brasil. El bajo nivel socioeconómico, ser madre soltera, antecedentes previos de trastorno mental, embarazo no planificado y multiparidad fueron factores de riesgo para los trastornos investigados.

RESUMO Objetivo: investigar a ocorrência e os fatores de risco ao transtorno mental comum e sintoma depressivo perinatal. Métodos: revisão integrativa da literatura, sendo utilizadas as bases de dados CINAHL, Embase, PubMed, PsycINFO e LILACS, buscando estudos conduzidos entre 2014 e 2019. A coleta de dados ocorreu entre junho e julho de 2019. Foram utilizados os Descritores em Ciências da Saúde (DeCS) e os Medical Subject Heading (MeSH) nas estratégias de busca empregadas em cada base de dados. Resultados: foram incluídos 13 artigos. A maioria dos estudos foi conduzido no Brasil e com delineamento transversal. As maiores prevalências de transtorno mental comum (63%) e de sintoma depressivo (30%) foram encontradas em estudos brasileiros. Conclusão: foram encontradas elevadas frequências para transtorno mental perinatal, com destaque para os estudos realizados no Brasil. Baixo nível socioeconômico, ser mãe solteira, história pregressa de transtorno mental, gravidez não planejada e multiparidade foram fatores de risco aos transtornos investigados.

Measuring suicide risk in the elderly with non-institutionalized depression: an integrative review / Evaluación del riesgo suicida en el anciano con depresión no institucionalizado: revisión integrativa / Mensuração do risco de suicídio no idoso com depressão não institucionalizado: revisão integrativa

ABSTRACT Objective: Analyze the state of the art about instruments, at national and international levels, for assessing the risk of suicide in elderly people with depression assisted in the community. Methods: Integrative review of 38 complete articles, published in journals indexed in the databases: US National Library of Medicine (PubMed Central), Scopus, CINAHL and Web of Science, located using controlled descriptors combined with Boolean operators: elderly OR aged OR older OR elder OR geriatric AND depression AND suicide AND risk assessment. Results: Six instruments were found, all international and published in the English language, in order to identify suicidal behavior and ideation in the elderly. Of these, two are specific scales for assessing the risk of suicide in the elderly in the community: 5-item GDS subscale and Geriatric Suicide Ideation Scale. Final considerations: With the scarcity of national instruments to assess such risk, research is recommended to cross-culturally adapt one of these scales to the Brazilian Portuguese language.

RESUMEN Objetivo: Analizar el estado del arte acerca de los instrumentos, en ámbitos nacional e internacional, de evaluación del riesgo suicida en ancianos con depresión asistidos en la comunidad. Métodos: Revisión integrativa de 38 artículos completos, publicados en periódicos indexados en las bases de datos: US National Library of Medicine (PubMed Central), Scopus, CINAHL y Web of Science, localizados mediante descriptores controlados combinados con operadores booleanos: elderly OR aged OR older OR elder OR geriatric AND depression AND suicide AND risk assessment. Resultados: Se localizaron seis instrumentos, todos internacionales y publicados en lengua inglesa, con objetivo de identificar comportamiento e ideación suicida en ancianos. De estos, dos son escalas específicas para evaluación del riesgo suicida en ancianos en la comunidad: 5-item GDS subscale y Geriatric Suicide Ideation Scale. Consideraciones finales: Con la escasez de instrumentos nacionales para evaluar tal riesgo, se recomienda investigación para adaptar transculturalmente una de esas escalas a la lengua portuguesa brasileña.

RESUMO Objetivo: Analisar o estado da arte acerca dos instrumentos, em âmbitos nacional e internacional, de avaliação do risco de suicídio em idosos com depressão assistidos na comunidade. Métodos: Revisão integrativa de 38 artigos completos, publicados em periódicos indexados nas bases de dados: US National Library of Medicine (PubMed Central), Scopus, CINAHL e Web of Science, localizados mediante descritores controlados combinados com operadores booleanos: elderly OR aged OR older OR elder OR geriatric AND depression AND suicide AND risk assessment. Resultados: Localizaramse seis instrumentos, todos internacionais e publicados na língua inglesa, com objetivo de identificar comportamento e ideação suicida em idosos. Destes, dois são escalas específicas para avaliação do risco de suicídio em idosos na comunidade: 5-item GDS subscale e Geriatric Suicide Ideation Scale. Considerações finais: Com a escassez de instrumentos nacionais para avaliar tal risco, recomenda-se pesquisa para adaptar transculturalmente uma dessas escalas à língua portuguesa brasileira.

Clinical observation of filiform fire needling on moderate and severe pain in advanced cancer / 中国针灸

OBJECTIVE@#To evaluate the clinical effect of filiform fire needling on moderate and severe pain in advanced cancer.@*METHODS@#A total of 66 patients with moderate and severe pain in advanced cancer were randomly divided into an observation group (34 cases, 4 cases dropped off) and a control group (32 cases, 2 cases dropped off). The two groups were treated with oral analgesics continuously for 4 weeks. The moderate pain patients was given bucinnazine hydrochloride tablets (starting at 30 mg, once every 6 hours, increasing by 30%-50% until the titration volume was reached), and the severe pain patients were given oxycodone hydrochloride sustained-release tablets (starting at 20 mg every 12 hours and increasing by 25%-50% until the titration volume was reached). The observation group was cooperated with filiform fire needling at point, Zusanli (ST 36), Liangqiu (ST 34), Qihai (CV 6), Guanyuan(CV 4), Quchi (LI 11) and Waiguan (TE 5) once every other day for 4 weeks. The changes of numerical rating scales (NRS) scores were observed in both groups before and after treatment, and the amount of analgesics and the incidence of adverse reactions were recorded. The clinical effects in the two groups were evaluated.@*RESULTS@#The effective rate was 90.0% (27/30) in the observation group, which was higher than 66.7% (20/30) in the control group (<0.05). After treatment, the NRS scores of both groups were lower than those before treatment (<0.05), and the reducing degree in the observation group was larger than that in the control group (<0.05). The average dosage of bunarizine hydrochloride tablets and oxycodone hydrochloride sustained release tablets to titration volume in the observation group was less than that in the control group (<0.05). The incidence of adverse reactions was 23.3% (28/120) in the observation group, which was lower than 44.2% (53/120) in the control group (<0.05).@*CONCLUSION@#Filiform fire needling can alleviate pain symptoms of patients with moderate and severe pain in advanced cancer, reduce the amount of analgesics, and decrease the incidence of adverse reactions.

Clinical study on Jin's three-needle therapy for post-stroke cognitive impairment / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of Jin's three-needle therapy on post-stroke cognitive impairment (PSCI) and the effect on neuroelectrophysiology (event-related potentials). Methods: A total of 60 PSCI patients were selected and divided into a treatment group and a control group according to the method of random number table, with 30 cases in each group. The patients in the control group received routine treatment while the patients in the treatment group received additional Jin's three-needle therapy. The treatment for both groups lasted four weeks. Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) scores as well as amplitude and latency of potential 300 (P300) were adopted to compare the between-group results before and after treatment. Results: Before treatment, there were no significant differences (all P>0.05) in MMSE and MoCA scores, P300 latency and P300 amplitude between the two groups. After 4 weeks of treatment, the MMSE and MoCA scores and P300 amplitudes were improved in both groups, and the P300 latencies became shorter. The results showed significant intra-group and between-group differences (all P<0.05). Conclusion: Based on the routine treatment, Jin's three-needle therapy is effective for PSCI. The mechanism is probably through its regulation on the patients' neuroelectrophysiology.

SIGMA-VB: Validity and reliability of the Brazilian Portuguese version of the Montgomery-Åsberg Depression Rating Scale using the Structured Interview Guide for the MADRS

Objective: The Montgomery-Åsberg Depression Rating Scale (MADRS) is widely used to assess depression severity. The Structured Interview Guide for the MADRS (SIGMA) was created to standardize MADRS assessment. The objective of this study was to translate and validate the original SIGMA into a Brazilian Portuguese version (SIGMA-VB). Methods: We translated and cross-culturally validated the original SIGMA into the SIGMA-VB, and assessed its psychometric properties using data from 93 adult outpatients enrolled in the Integral Assessment in Unipolar Depression (AIUNI) trial. Participants were assessed by two raters on five visits over 8 weeks. We calculated multiple interrater reliability indexes for the SIGMA-VB and used the Hamilton Depression Hating Scale (HAM-D) for validation purposes. Results: According to the SIGMA-VB, participants had moderate depression at baseline followed by mild depression at 8 weeks. We found over 90% of correlation between scores attributed by different raters using the SIGMA-VB. Correlations between the SIGMA-VB and the HAM-D were above 66%. Conclusion: Our findings confirm that the SIGMA-VB is a valid and reliable instrument to assess depression severity in clinical research and practice. Its interrater reliability was similar to that of a previously published Japanese version of the SIGMA.

Cuestionarios de valoración funcional en traumatología / Trauma functional assessment questionnaires

RESUMEN Introducción: Las enfermedades musculoesqueléticas son dolencias de alta prevalencia, impacto y repercusión. La historia clínica y las pruebas complementarias son las primeras pautas para diagnosticarlas. Se recomienda el uso de cuestionarios para la valoración de las limitaciones e impacto en la calidad de vida de los pacientes. Objetivo: Valorar el uso y eficacia de los cuestionarios en traumatología. Métodos: Se revisaron las bases de datos Medline, Pubmed. Se obtuvieron 32 publicaciones, fundamentalmente, en inglés, aunque también en español y otros idiomas, realizadas entre 2001-2018, que recogen la experiencia de los investigadores con el uso de los cuestionarios. Los términos de búsqueda empleados fueron: Musculoskeletal Disorders, Musculoskeletal pain; and Foot and Ankle, hip and knee, Upper Extremity, low back pain; and disability, quality of life questionnaires and assessment tool. Resultados: Se han revisado 46 cuestionarios: 4 de calidad de vida, 16 de miembro superior (1 general y 15 por localización de la lesión), 19 de miembro inferior (4 generales y 15 por localización de la lesión) y 7 para raquis. Conclusiones: No hay acuerdo en los autores sobre cuál es el mejor cuestionario para la valoración de impacto y repercusión, y se combinan varios de ellos. La elección del cuestionario y el que sea genérico (de calidad de vida) o específico (de miembro superior, inferior o raquis), está en consonancia con el objetivo buscado en la investigación, la experiencia del investigador, su uso clínico y tiempo necesario para cumplimentarlo(AU)

ABSTRACT Introduction: Musculoskeletal diseases are ailments of high prevalence, impact and impact. The medical record and the complementary tests are the first guidelines to diagnose them. The use of questionnaires is recommended to assess the limitations and impact on the quality of life of patients. Objective: To assess the use and effectiveness of traumatology questionnaires. Methods: Medline, Pubmed databases were reviewed. We recovered 32 publications mainly in English, but also in Spanish and other languages, made from 2001 to 2018. These publications collect the experience of researchers with the use of questionnaires. The search terms used were Musculoskeletal Disorders, Musculoskeletal pain; and Foot and Ankle, hip and knee, Upper Extremity, low back pain; and disability, quality of life questionnaires and assessment tool. Results: Forty six questionnaires were reviewed. Four on quality of life, 16 on the upper limbs (one general and 15 by location of the lesion), 19 on the lower limbs (four general and 15 by location of the lesion) and 7 on spine. Conclusions: There is no consensus among the authors on which is the best questionnaire for assessing of the impact and repercussion. Several of them are combined. The choice of the questionnaire and the one that is generic (on quality of life) or specific (on upper, lower limbs or spinal) is in line with the objective sought in this research, the researcher´s experience, clinical use and the time needed to fill it out(AU)

RÉSUMÉ Introduction: Les troubles musculo-squelettiques sont des affections dont la prévalence, l'impact et le retentissement sont élevés. Le dossier médical et les examens complémentaires sont les premières orientations pour les diagnostiquer. L'emploi des questionnaires pour évaluer les limitations et l'impact sur la qualité de vie des patients est recommandé. Objectif: Évaluer l'emploi et l'efficacité des questionnaires en traumatologie. Méthodes: On a consulté les bases de données Medline et PubMed. On a obtenu 32 publications notamment en anglais, mais aussi en espagnol et d'autres langues, parues entre 2001-2018, recueillant toute l'expérience des chercheurs dans l'usage des questionnaires. Les termes de recherche utilisés ont été: Musculoskeletal Disorders, Musculoskeletal pain ; and Foot and Ankle, hip and knee, Upper Extremity, low back pain ; and disability, quality of life questionnaires and assessment tool. Résultats: Sur 46 questionnaires, on a révisé 4 concernant la qualité de vie, 16 concernant les membres supérieurs (1 de sujet général et 15 de localisation de la lésion), 19 concernant les membres inférieurs (4 de sujet général et 15 de localisation de la lésion), et 7 concernant le rachis. Conclusions: Les auteurs ne sont pas arrivés à un consensus sur le meilleur questionnaire pour évaluer l'impact et le retentissement; on a fait une combinaison de plusieurs d'entre eux. La sélection d'un questionnaire et le fait qu'il soit générique (qualité de vie) ou spécifique (membre supérieur, inférieur ou rachis) ont été en concordance avec l'objectif de la recherche, l'expérience du chercheur, l'usage clinique et le temps nécessaire pour le compléter(AU)

Propiedades psicométricas de la escala EMUN-AR determinadas mediante el análisis de Rasch / Psychometric variables of the EMUN-AR scale using Rasch analysis

Resumen Introducción. Las escalas de autorreporte se han considerado útiles para evaluar y vigilar los síntomas de la enfermedad maníaco-depresiva. Uno de estos instrumentos, la escala de medición de la enfermedad maníaco-depresiva mediante autorreporte (EMUN-AR), no se ha validado aún. Objetivo. Validar la escala EMUN-AR usando el modelo de Rasch. Materiales y métodos. La escala EMUN-AR mide 26 ítems que evalúan por dimensiones los síntomas de la enfermedad maníaco-depresiva en tres categorías: frecuencia, intensidad y grado de molestia causada. Para evaluar las propiedades psicométricas de la escala, se efectuaron análisis factoriales exploratorios con el fin de tener una aproximación de su estructura latente, y se usaron modelos de Rasch que incluyeron la 'unidimensionalidad', la confiabilidad, el ajuste de ítems, el ordenamiento de umbrales, y los mapas de personas e ítems. Resultados. Se seleccionó una muestra de 267 pacientes hospitalizados, 204 de los cuales había sufrido un episodio maníaco (76,4 %) y estaba recibiendo tratamiento farmacológico. Se encontró una estructura factorial que puede resumirse en cuatro dominios: activación, inhibición, ideas depresivas e inadaptación. El análisis de Rasch evidenció la unidimensionalidad en los factores, adecuados valores de confiabilidad, buen ajuste de los 26 ítems en general (excepto en el ítem que mide las ideas de muerte o suicidio), un funcionamiento deficiente del sistema de calificación de los ítems y un cubrimiento limitado de los síntomas de la enfermedad correspondientes a las formas atenuadas. Conclusión. Se modificó la escala original en dos aspectos: se ajustó un ítem cuyos indicadores marginales tenían mal ajuste y se redujo el número de categorías. En su forma actual, el instrumento es apropiado para medir las formas graves de la enfermedad maníaco-depresiva, mas no así las atenuadas.

Abstract Introduction: Self-report scales have been considered to be useful for evaluating and monitoring symptoms of manic-depressive illnesses. The EMUN-AR scale is one of such scales but it has not been validated. Objective: To validate the EMUN-AR scale using Rasch models. Materials and methods: The EMUN-AR scale measures 26 items to assess comprehensively symptoms of manic-depressive illnesses in three domains: Frequency, severity, and level of disturbance caused by the symptoms. To test the psychometric properties of this scale, we used the exploratory factorial and Rasch analyses. The Rasch analysis included unidimensionality, reliability, item fit, threshold ordering, and person-item maps. Results: The study included 267 hospitalized patients, most of them with a manic episode diagnosis (n=204, 76.4%), and receiving pharmacological treatment. The factor structure was summarized in four domains: Activation, inhibition, depressive ideation, and maladaptive behavior. The Rasch analysis supported unidimensionality of the EMUN-AR factors, satisfactory levels of reliability, and appropriate item fit, except for one of the items measuring death or suicidal thoughts. However, the scale did not measure adequately the mild forms of the illness given its redundant and unordered thresholds. Conclusion: The EMUN-AR was modified in two aspects: An item whose marginal indicators were poorly adjusted and the reduction in the number of categories. In its current form, the EMUN-AR is appropriate for measuring severe forms of the illnesses, but it does not adequately measure the mild forms of manic-depressive illnesses.

Challenges for Behavioral Assessment in Brazilian Schools / Desafios para avaliação comportamental nas escolas brasileiras

In this article we begin by providing an overview of the need to increase the frequency with which behavioral assessment is used in Brazilian schools. We then describe various methods of behavioral assessment. Next, we discuss various purposes for assessing behavior in school settings. We then discuss general challenges that impact the assessment of behavior. Finally, we conclude by discussing the importance of identifying psychological and social concerns early in childhood and call for the development of additional evidence-based assessment tools that are appropriate for use in Brazilian schools.

Neste artigo, iniciamos com uma visão geral da necessidade de aumentar a frequência com qual avaliações de comportamento são utilizadas nas escolas brasileiras. Daí, descrevemos vários métodos de avaliações de comportamento. Próximo, discutimos os vários propósitos da avaliação do comportamento no ambiente escolar. Nós discutimos os desafios gerais que influenciam a avaliação do comportamento. Finalmente, concluímos com uma discussão sobre a importância da identificação de problemas psicológicos e sociais cedo durante a infância, e realçamos a necessidade do desenvolvimento de avaliações e ferramentas adicionais baseadas em evidências, que seriam apropriadas para uso nas escolas brasileiras

A review of breastfeeding assessment tools / 中华围产医学杂志

Breastfeeding, as the optimal feeding pattern, ensures the physical, neurological and psychological growth and development of infants. Professional evaluation of breastfeeding with assessment tools facilitates identifying critical influencing factors and providing specific guidance and health education. This review summarized the breastfeeding assessment tools at home and abroad to provide reference for clinical practice and research.

Obstetric factors for maternal depression/anxiety / 中华围产医学杂志

Objective To investigate the current situation of depression/anxiety in gravidas and to analyze the related obstetric factors.Methods A questionnaire survey was conducted among 6 923 gravidas who registered for their first prenatal examination at Obstetrics and Gynecology Hospital of Fudan University from September 2015 to September 2016.Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were completed during the survey and general obstetric conditions and medical history were reviewed.Related obstetric factors were statistically analyzed by Chi-square test and logistic regression.Results In this study,the positive rates of depression and anxiety screening were 23.15％ (1 603/6 923) and 9.56％ (659/6 893),respectively.Univariate analysis showed that maternal depression was associated with maternal age,gravidity,parity and history of adverse pregnancies (all P＜0.05),while anxiety was related to maternal age,gravidity and history of adverse pregnancies (all P＜0.05).Multivariate analysis showed that younger gravidas (＜25 years old) had higher risks of depression and anxiety than those aged between 25 and 35 (OR=2.945,95％CI:2.266-3.829;OR=1.959,95％CI:1.381-2.780;both P＜0.05).Compared to primiparas with a history of conception,the first-time pregnant women had lower risks of depression and anxiety (OR=0.732,95％CI:0.630-0.851;OR=0.630,95％CI:0.512-0.775;both P＜0.05),and the risk of anxiety in multiparas was also decreased (OR=0.748,95％CI:0.561-0.996,P＜0.05).In addition,gravidas with previous adverse pregnant outcome showed higher risks of depression and anxiety (OR=1.549,95％CI:1.123-2.137;OR=1.712,95％CI:1.138-2.577;both P＜0.05).Conclusions The positive rates of depression and anxiety are high in gravidas,especially younger or primiparas with a history of conception and those with history of adverse pregnancies.Clinicians should pay attention to any obstetric factors related to maternal depression and anxiety.

Avaliação de delirium com uso do modelo PRE-DELIRIC em uma unidade de terapia intensiva na Argentina / Assessment of delirium using the PRE-DELIRIC model in an intensive care unit in Argentina

RESUMO Objetivo: Descrever a incidência e os fatores de risco para delirium na unidade de terapia intensiva de um hospital terciário de ensino na Argentina, e conduzir o primeiro estudo não europeu para explorar o desempenho do modelo PREdiction of DELIRium in ICu Patients (PRE-DELIRIC). Métodos: Estudo prospectivo observacional em uma unidade de terapia intensiva com 20 leitos localizada em um hospital terciário de ensino em Buenos Aires, Argentina. O modelo PRE-DELIRIC foi aplicado a 178 pacientes consecutivos dentro de 24 horas após sua admissão à unidade de terapia intensiva. Avaliou-se o delirium com uso da ferramenta Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Resultados: A média de idade foi de 64,3 ± 17,9 anos. O tempo mediano de permanência na unidade de terapia intensiva foi de 6 dias (variação entre 2 e 56 dias). Dentre o total de pacientes, 49/178 (27,5%) desenvolveram delirium, definido como avaliação positiva segundo a CAM-ICU, durante a permanência na unidade de terapia intensiva. Os pacientes no grupo com delirium eram significantemente mais velhos e tinham escore Acute Physiological and Chronic Health Evaluation II (APACHE II) significantemente mais elevado. A taxa de mortalidade na unidade de terapia intensiva foi de 14,6%; não se observou diferença significante entre os dois grupos. Os fatores preditivos para desenvolvimento de delirium foram idade mais avançada, tempo prolongado de permanência na unidade e uso de opioides. A área sob a curva para o modelo PRE-DELIRIC foi de 0,83 (IC95%: 0,77 - 0,90). Conclusões: A incidência observada de delirium salienta a importância deste problema no ambiente da unidade de terapia intensiva. Neste primeiro estudo conduzido fora da Europa, o PRE-DELIRIC previu de forma precisa o desenvolvimento de delirium.

ABSTRACT Objective: To describe the incidence of and risk factors for delirium in the intensive care unit of a tertiary care teaching hospital in Argentina and to conduct the first non-European study exploring the performance of the PREdiction of DELIRium in ICu patients (PRE-DELIRIC) model. Methods: Prospective observational study in a 20-bed intensive care unit of a tertiary care teaching hospital in Buenos Aires, Argentina. The PRE-DELIRIC model was applied to 178 consecutive patients within 24 hours of admission to the intensive care unit; delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Results: The mean age was 64.3 ± 17.9 years. The median time of stay in the intensive care unit was 6 (range, 2 - 56) days. Of the total number of patients, 49/178 (27.5%) developed delirium, defined as a positive CAM-ICU assessment, during their stay in the intensive care unit. Patients in the delirium group were significantly older and had a significantly higher Acute Physiological and Chronic Health Evaluation II (APACHE II) score. The mortality rate in the intensive care unit was 14.6%; no significant difference was observed between the two groups. Predictive factors for the development of delirium were increased age, prolonged intensive care unit stay, and opioid use. The area under the curve for the PRE-DELIRIC model was 0.83 (95%CI; 0.77 - 0.90). Conclusions: The observed incidence of delirium highlights the importance of this problem in the intensive care unit setting. In this first study conducted outside Europe, PRE-DELIRIC accurately predicted the development of delirium.

Transcultural adaptation to the Brazilian Portuguese of the Postpartum Bonding Questionnaire for assessing the postpartum bond between mother and baby / Adaptação transcultural para o português do Brasil do Postpartum Bonding Questionnaire para avaliação do vínculo no pós-parto entre mãe e bebê / Adaptación transcultural al portugués brasileño del Postpartum Bonding Questionnaire para evaluar el vínculo en el posparto entre la madre y el bebé

Abstract: The establishment of the bond between mother and baby in the postpartum period is important for ensuring the physical and psychological health of both. This short communication reports the first phase of the cross-cultural translation and adaptation to the Brazilian context of the Postpartum Bonding Questionnaire (PBQ). Four aspects of equivalence between the original scale and the Portuguese version were evaluated: the conceptual, semantic, operational and item equivalences. Literature review, the study of PBQ history, translation, expert evaluation, back-translation and pretests involving 30 mothers with children aging up to 7 months using a primary healthcare unit were conducted. Each step demonstrated the need for adjustments, which were made during the adaptation process. At the end of the study, a version of PBQ in Brazilian Portuguese equivalent to the original one was obtained, offering promise for national studies on the mother-baby bond, and its influence on health, and for use in health services.

Resumo: O estabelecimento do vínculo entre mãe e bebê no período pós-parto é importante para garantir a saúde física e psicológica de ambos. Esta artigo relata a primeira fase da tradução e adaptação transcultural ao contexto brasileiro do Postpartum Bonding Questionnaire (PBQ). Quatro aspectos de equivalência entre a escala original e a versão em português foram avaliados: as equivalências conceitual, semântica, operacional e de item. Foi realizada revisão de literatura, estudo da história do PBQ, tradução, avaliação por especialistas, retrotradução e pré-testes envolvendo 30 mães com crianças com até sete meses de idade, que utilizaram unidades básicas de saúde. Cada passo demonstrou a necessidade de ajustes, que foram feitos durante o processo de adaptação. Ao final do estudo, obteve-se uma versão do PBQ em português do Brasil equivalente à original, possibilitando estudos nacionais sobre o vínculo mãe-bebê e sua influência na saúde e uso nos serviços de saúde.

Resumen: El establecimiento del vínculo entre la madre y el bebé en el período posparto es importante para garantizar la salud física y psicológica de ambos. Este artículo informa la primera fase de la traducción y adaptación transcultural al contexto brasileño del Postpartum Bonding Questionnaire (PBQ). Se evaluaron cuatro aspectos de la equivalencia entre la escala original y la versión en portugués: las equivalencias conceptuales, semánticas, operacionales y de ítem. Se realizó una revisión de la literatura, el estudio de la historia de PBQ, la traducción, la evaluación de expertos, la retrotraducción y los exámenes previos que involucraron a 30 madres con niños de hasta siete meses que usaban una unidad de salud primaria. Cada paso demostró la necesidad de ajustes, que se realizaron durante el proceso de adaptación. Al final del estudio, se obtuvo una versión de PBQ en portugués de Brasil equivalente a la original, permitiendo estudios nacionales sobre el vínculo madre-bebé, y su influencia en la salud, y para su uso en los servicios de salud.