Effect of esketamine on cerebral ischemia-reperfusion injury and association with mitochondrial stress in mice / 中华麻醉学杂志

Objective:To evaluate the effect of esketamine on cerebral ischemia-reperfusion (I/R) injury and the association with mitochondrial stress in mice.Methods:The experiment was performed in two parts. Part Ⅰ Eighteen SPF male C57BL/6 mice, aged 8-12 weeks, with body mass index of 28-30 g, were divided into 3 groups ( n=6 each) by a random number table method: sham operation group (S group), cerebral I/R group (IR group), and esketamine plus cerebral I/R group (E+ IR group). Cerebral I/R was produced by occlusion of middle cerebral artery for 1 h followed by 24-h reperfusion in anesthetized mice.Esketamine 10 mg/kg was intraperitoneally injected at 20 min before developing the model in E group. Neurological function was evaluated using the Zea Longa score and balance beam test (Feeney score). The cerebral infarct size was determined by TTC staining. Part Ⅱ Primary cortical neurons were isolated and cultured and then divided into 3 groups ( n=42 each) using a random number table method: control group (group C), oxygen-glucose deprivation-reoxygenation (OGD/R) group, and esketamine plus OGD/R group (group E+ OGD/R). Cells were subjected to O 2-glucose deprivation for 1 h followed by restoration of O 2-glucose supply for 24 h. The cells were treated with 25 μmol/L esketamine for 40 min before preparing the model in E+ OGD/R group. The neuronal viability was measured by the CCK-8 assay. The ultrastructure of neurons was observed with a transmission electron microscope. The levels of reactive oxygen species (ROS), glutathione peroxidase (GSH-px) and malondialdehyde (MDA) were determined, and the mitochondrial membrane potential was determined by JC-1 kit. The neuronal apoptosis was detected by TUNEL staining, and the apoptosis rate of neurons was calculated. The expression of Bax, cytochrome C (CytC), cleaved-caspase-9, caspase-3 and cleaved-caspase-3 was detected by Western blot. Results:Part Ⅰ Compared with S group, the Zea Longa score, Feeney score and cerebral infarct size were significantly increased in IR group ( P<0.01). Compared with IR group, the Zea Longa score, Feeney score and cerebral infarct size were significantly decreased in E+ IR group ( P<0.01). Part Ⅱ Compared with C group, the cell viability and activity of GSH-px were significantly decreased, the apoptosis rate of neurons, levels of ROS and MDA, mitochondrial membrane potential, and cleaved-caspase-3/caspase-3 ratio were increased, and the expression of Bax, Cyt C and cleaved-caspase-9 was up-regulated in OGD/R group ( P<0.01). Compared with OGD/R group, the cell viability and activity of GSH-px were significantly increased, the apoptosis rate of neurons, levels of ROS and MDA, mitochondrial membrane potential, and cleaved-caspase-3/caspase-3 ratio were decreased, and the expression of Bax, Cyt C and cleaved-caspase-9 was down-regulated in E+ OGD/R group ( P<0.01). Conclusions:Esketamine can alleviate cerebral I/R injury in mice, and the mechanism may be related to inhibition of mitochondrial stress in neurons, improvement in mitochondrial function, and inhibition of mitochondria-dependent apoptosis in neurons.

Clinical study on ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture for awake tracheal intubation in difficult airways / 中国基层医药

Objective:To evaluate the clinical efficacy of ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture for awake tracheal intubation in difficult airways.Methods:A total of 80 patients scheduled for general anesthesia surgery owing to difficult airways at Marine Police Corps Hospital of Chinese People's Armed Police Force from August 2019 to February 2023 were included in this prospective study. These patients were randomly divided into a control group and an observation group ( n = 40 per group). Both groups of patients underwent fiberoptic bronchoscope-guided awake tracheal intubation through the nasal route. Before intubation, the control group received surface anesthesia combined with cricothyroid membrane puncture anesthesia, while the observation group received superior laryngeal nerve block combined with cricothyroid membrane puncture anesthesia. During the intubation process, hemodynamic indicators of the patients were monitored, the duration of the intubation operation was recorded, and the degree of sedation and cough response was evaluated. Before and after intubation, the levels of serum stress response factors were determined, and the satisfaction level of patients with the intubation operation was investigated. Results:At the time points T1 (immediately after the tracheal tube enters the glottis) and T2 (after the tracheal tube enters the trachea), the heart rate in the observation group was (84.08 ± 8.25) times/minute and (82.64 ± 7.81) times/minute, respectively, and the mean arterial pressure in the observation group was (92.57 ± 8.32) mmHg (1 mmHg = 0.133 kPa) and (103.27 ± 9.16) mmHg, respectively, which were significantly lower compared with those in the control group ( t = 5.92-12.56, all P < 0.001). At T1 and T2, there was no significant difference in blood oxygen saturation (SpO 2) between the observation and control groups ( t = 0.34-0.43, P = 0.652-0.726). The duration of the intubation operation in the observation group was (8.96 ± 1.15) minutes, which was significantly shorter than (11.47 ± 1.39) minutes in the control group ( t = 6.84, P < 0.001). The Ramsay sedation score during intubation in the observation group was 3 (2,3) points, which was significantly higher than 2 (1,3) points in the control group ( Z = 9.26, P < 0.001). The cough response score in the observation group was 1 (0,1) point, which was significantly lower than 1 (0, 2) points in the control group ( Z = 4.37, P < 0.001). The serum levels of stress response factors norepinephrine and adrenaline in the observation group were significantly lower than those in the control group ( t = 14.58-25.94, both P < 0.05). The overall patient satisfaction in the observation group was 97.50%, which was significantly higher than that in the control group ( χ2 = 4.51, P = 0.034). Conclusion:Superior laryngeal nerve block combined with cricothyroid membrane puncture can be used for anesthetic management of awake nasal tracheal intubation in difficult airways. This combined approach can improve patient hemodynamic stability and sedation, shorten the duration of intubation, reduce stress responses during intubation, and enhance patient satisfaction.

Analgesic effect of different regional block techniques guided by ultrasound in older adult patients undergoing inguinal hernia repair surgery / 中国基层医药

Objective:To investigate the analgesic effect of ultrasound-guided transversus abdominis plane block versus ultrasound-guided quadratus lumborum block in older adult patients undergoing inguinal hernia repair surgery. Methods:A total of 150 older adult patients who underwent inguinal hernia repair surgery at the Marine Police Corps Hospital of Chinese People's Armed Police Force from April 2019 to May 2022 were included in this study. They were randomly divided into a control group ( n = 75) and a study group ( n = 75) using a random number table method. All patients underwent elective laparoscopic tension-free inguinal hernia repair surgery. Patients in the control group received ultrasound-guided transversus abdominis plane block after inguinal hernia repair surgery, while those in the study group received ultrasound-guided quadratus lumborum block. The changes in Visual Analog Scale (VAS) score and Ramsay score within 48 hours after surgery were compared between the two groups. Inflammatory factors and stress factors including serum tumor necrosis factor alpha, interleukin-6, norepinephrine, and cortisol, were measured at 24 and 48 hours after surgery. The use of analgesics, drug-related adverse reactions, and incidence of nerve block-related complications within 48 hours after surgery were also compared between the two groups. Results:There was no significant difference in Ramsay score between the two groups at 4, 8, 12, 24, and 48 hours after surgery (all P > 0.05). There was no significant difference in VAS score between the two groups at 4 and 8 hours after surgery (both P > 0.05). At 12, 24, and 48 hours after surgery, the VAS score in the study group was (1.36 ± 0.57) points, (2.05 ± 0.56) points, and (1.79 ± 0.55) points, respectively, which were significantly lower than (1.92 ± 0.59) points, (2.68 ± 0.62) points, and (2.36 ± 0.59) points in the control group ( t = 6.65, 7.31, 5.86, all P < 0.001). At 24 and 48 hours after surgery, serum tumor necrosis factor alpha, interleukin-6, norepinephrine, and cortisol levels in the study group [24 hours: (63.89 ± 4.65) ng/L, (156.59 ± 8.62) ng/L, (97.02 ± 6.95) g/L, (36.95 ± 3.26) g/L; 48 hours: (49.66 ± 3.74) ng/L, (131.45 ± 7.73) ng/L, (74.63 ± 5.91) g/L, (30.41 ± 2.96) g/L] were significantly lower than those in the control group [24 hours: (76.42 ± 5.17) ng/L, (189.32 ± 10.41) ng/L, (105.53 ± 7.83) g/L, (45.16 ± 3.74) g/L; 48 hours: (58.15 ± 3.94) ng/L, (162.74 ± 8.49) ng/L, (89.51 ± 6.37) g/L, (36.92 ± 3.31) g/L, t = 10.49-26.38, all P < 0.001]. The proportion of patients who received analgesics within 48 hours after surgery in the study group was 8.00% (6/75), which was significantly lower than 25.33% (19/75) in the control group ( χ2 = 8.11, P = 0.004). The overall incidence of drug-related adverse reactions within 48 hours after surgery in the study group [6.67% (3/75)] was significantly lower than that in the control group [11% (11/75), χ2 = 4.61, P = 0.032]. Conclusion:Compared with ultrasound-guided transversus abdominis plane block, ultrasound-guided quadratus lumborum block better helps alleviate postoperative pain in older adult patients undergoing inguinal hernia repair surgery, inhibits inflammation and stress reactions, reduces the dosage of analgesic drugs, and decreases the incidence of adverse drug reactions.

Angústia moral entre médicos em terapia intensiva pediátrica / Moral distress among physicians working in pediatric intensive care / Angustia moral entre los médicos en cuidados intensivos pediátricos

Resumo Este estudo tem como objetivo entender e interpretar a ocorrência de angústia moral entre médicos intensivistas pediátricos que atuam em uma Unidade de Terapia Intensiva Pediátrica. Trata-se de uma pesquisa exploratória e descritiva, de abordagem quantitativa e recorte transversal, com foco na aplicação de um instrumento de pesquisa baseado na Moral Distress Scale Revised para levantamento da presença de angústia moral em 43 médicos de determinada unidade de terapia. A maioria das respostas do instrumento de pesquisa quanto à presença de angústia moral esteve relacionada a questões de fim de vida, situações de prolongamento penoso da vida, comunicação deficiente entre a equipe, problemas de saúde do profissional, desconforto com prognósticos incertos, necessidade de visitas multiprofissionais e sofrimento do paciente. O intuito foi buscar evidências na pesquisa sobre determinadas situações que podem ser desencadeadoras de angústia moral com intensidades e frequências distintas entre os profissionais, de acordo com algumas variáveis.

Abstract This study investigates and interprets the occurrence of moral distress among pediatric physicians working in a Pediatric Intensive Care Unit. A cross-sectional, exploratory, descriptive research was conducted to survey the presence of moral distress among 43 physicians from a specific therapy unit assessed by the Moral Distress Scale Revised. Most responses regarding the presence of moral distress revolved around end-of-life issues, painful life-prolonging situations, poor team communication, professional health problems, discomfort with uncertain prognoses, need for multidisciplinary visits and patient suffering. We sought evidence in research on certain situations that can trigger moral distress at different intensities and frequencies among professionals, according to some variables.

Resumen Este estudio tiene como objetivo comprender e interpretar la angustia moral entre los médicos en cuidados intensivos pediátricos que trabajan en una Unidad de Cuidados Intensivos Pediátricos. Se trata de una investigación exploratoria, descriptiva, de enfoque cuantitativo y transversal, centrada en la aplicación de una herramienta basada en la Moral Distress Scale Revised para identificar la presencia de angustia moral en 43 médicos(as) de una unidad específica. La mayoría de las respuestas a la herramienta de evaluación sobre la presencia de sufrimiento moral giraron en torno a cuestiones del final de la vida, situaciones dolorosas que prolongan la vida, mala comunicación entre el equipo, problemas de salud profesional, malestar ante pronósticos inciertos, necesidad de visitas multidisciplinarias y sufrimiento del paciente. El objetivo fue buscar evidencias sobre determinadas situaciones que pueden desencadenar angustia moral con diferentes intensidades y frecuencias entre los profesionales según algunas variables.

Efecto del estrés agudo y de la variación del estímulo masticatorio sobre el dolor nociceptivo somático en un modelo murino

Introducción. El estrés agudo se relaciona con la enérgica liberación de catecolaminas, citoquinas y cortisol, las cuales afectan la percepción dolorosa. La masticación estimula neuronas serotoninérgicas, dichas neuronas modulan a las vías neurales del dolor; sin embargo, la relación entre dichas variables aún está en proceso de entendimiento. Objetivo. Determinar el efecto del estrés agudo y del estímulo masticatorio sobre el dolor. Métodos. Experimento que se desarrolló en el bioterio de la Facultad de Medicina de la UNMSM. 40 ratones Balb/c machos de 8 semanas de edad. Los ratones fueron asignados aleatoriamente en 5 grupos iguales. A: semana 1 sin ningún estímulo y semana 2 estimulo masticatorio + estrés. B: semana 1 sin ningún estímulo y semana 2 estrés. C: semana 1 estrés y semana 2 sin ningún estímulo. D: semana 1 estímulo masticatorio + estrés y semana 2 sin ningún estímulo. E: control, sin ningún estimulo. El dolor se evaluó en los 5 grupos a los 7 y 14 días mediante la prueba de tiempo de retirada de la cola ante estímulo térmico. Resultados. Se empleó la prueba de ANOVA para la evaluación intergrupo, no hallándose diferencia significativa. Mediante la prueba de t student para muestras relacionadas se hizo la evaluación intragrupo donde se encontró diferencia significativa entre los 7 vs los 14 días tanto en el grupo A (p=0,029) como en el grupo C (p=0,03). Conclusión. El efecto del estrés agudo sobre la percepción dolorosa fue disminuida por el estímulo masticatorio en ratones Balb/c.

Introduction. Acute stress is related to the energetic release of catecholamines, cytokines, and cortisol, which trigger pain perception. Chewing stimulates serotonergic neurons, these neurons modulate the neural pathways of pain; however, the relationship between these variables is still in the process of understanding. Objective. To determine the effect of acute stress and chewing stimulus on pain. Methods. an experiment that was developed in the Faculty of Medicine of the UNMSM. 40 eight-week-old male Balb/c mice were randomly assigned into 5 equal groups. A: week 1 without any stimulus and week 2 chewing stimulus + stress. B: week 1 without any stimulus and week 2 stress. C: week 1 stress and week 2 without any stimulus. D: week 1 masticatory stimulus + stress and week 2 without any stimulus. E: control, without any stimulus. Pain was assessed in the 5 groups at 7 and 14 days using the tail-withdrawal time test before thermal stimulation. Results. The ANOVA test was used for the intergroup evaluation, finding no significant difference. Using the t student test for related samples, the intragroup evaluation was made, where a significant difference was found between 7 vs. 14 days, both in group A (p=0.029) and in group C (p=0.03). Conclusion. The effect of acute stress on pain perception was decreased by chewing stimulus in Balb/c mice.

Estrés académico autopercibido y factores relacionados en una escuela privada de odontología en Cartagena, Colombia / Self-perceived academic stress and related factors in a private dental school from Cartagena, Colombia / Estresse acadêmico auto-percebido e fatores relacionados em uma escola particular de odontologia em Cartagena, Colômbia

Introducción: El estrés académico surge de una interacción entre factores estresantes ambientales y las reacciones de los estudiantes, asociándose con frustración y fracaso académico. Además, algunos factores demográficos y familiares influyen en el estrés. Objetivo: Analizar estrés académico, factores demográficos y familiares en estudiantes de Odontología en Escuela privada de Cartagena. Materiales y métodos: Estudio descriptivo de corte transversal, en 158 estudiantes. Se aplicó cuestionario sociodemográfico, APGAR familiar e inventario SISCO. Se analizó los datos mediante estadística descriptiva y prueba X2. Resultados: Se encontró disfuncionalidad familiar y mal soporte de amigos en casi la mitad de los participantes, niveles de preocupación moderada cercana a 70%, alta frecuencia de demandas del entorno (estresores), reacciones comportamentales y presencia de síntomas ante estímulo estresor. Hubo asociación entre alta frecuencia de inquietud en situaciones cotidianas y pertenecer a semestres básicos, baja frecuencia de uso de estrategias de afrontamiento y sexo femenino, alta frecuencia de reacciones comportamentales y disfunción familiar. Conclusiones: Los principales factores identificados fueron pertenecer a semestres básicos, ser mujer y presencia de disfuncionalidad familiar. Los niveles de estrés y disfuncionalidad familiar sugieren una alerta para intervenir desde bienestar universitario, previniendo condiciones desfavorables en la salud y rendimiento académico de los estudiantes.

Introduction: Academic stress arises from an interaction between environmental stressors and student reactions, which are associated with academic frustration and academic failure. Likewise, there are demographic and family factors that affect stress. Objective: To analyze academic stress, demographic and family factors in Dentistry students at a private school in Cartagena. Materials and methods: A descriptive cross-sectional study with 158 students. The APGAR family sociodemographic questionnaire and SISCO inventory were used. Descriptive statistics and the X2 test were applied to analyze data. Results: Family dysfunction and low friend support were observed in almost half of the participants, 70% displayed moderate anxiety levels. Also, a high frequency of environmental demands (stressors), behavioral reactions, and the presence of symptoms in response to the stressors were found. There were associations between: high frequency of restlessness in everyday situations and belonging to initial semesters; low frequency of using coping strategies and female gender; and high frequency of behavioral reactions and family dysfunction. Conclusions: The main factors identified were belonging to initial semesters, being a woman, and family dysfunction. Levels of stress and family dysfunction can be used as a signal for university welfare services to intervene and prevent unfavorable student health and academic performance conditions.

Introdução: O estresse acadêmico surge de uma interação entre os estressores ambientais e as reações dos alunos, associados à frustração e ao fracasso acadêmico. Além disso, alguns fatores demográficos e familiares influenciam o estresse. Objetivo: Analisar o estresse acadêmico, fatores demográficos e familiares em estudantes de odontologia de uma escola particular de Cartagena. Materiais e métodos: Estudo transversal descritivo, em 158 estudantes. Questionários sociodemográficos, APGAR familiar e inventário SISCO foram aplicados. Os dados foram analisados por meio de estatística descritiva e teste X2. Resultados: Disfunção familiar e pouco apoio dos amigos foram encontrados em quase metade dos participantes, níveis de preocupação moderada próximos a 70 %, alta frequência de demandas do ambiente (estressores), reações comportamentais e presença de sintomas diante de estímulos estressantes. Houve associação entre alta frequência de inquietação em situações cotidianas e pertencimento aos semestres básicos, baixa frequência do uso de estratégias de enfrentamento e sexo feminino, alta frequência de reações comportamentais e disfunção familiar. Conclusões: Os principais fatores identificados foram pertencer aos semestres básicos, ser mulher e a presença de disfunção familiar. Os níveis de estresse e disfuncionalidade familiar sugerem um alerta para intervir da unidade de bem-estar da universidade para prevenir condições desfavoráveis na saúde e desempenho acadêmico dos estudantes.

Efecto del estímulo masticatorio y estrés agudo sobre la interleuquina 6, la memoria y el aprendizaje espacial en ratones Balb/c

Introducción. El estrés agudo altera la memoria y aprendizaje espacial y la expresión de la interleuquina 6 (IL-6), mientras que el estímulo masticatorio evitaría dichos efectos. Objetivo. Determinar el efecto del estímulo masticatorio y el estrés agudo sobre la expresión de interleuquina 6, la memoria y el aprendizaje espacial en ratones. Métodos. Experimento con 70 ratones albinos machos de 2 meses de edad de la cepa Balb/c que fueron distribuidos aleatoriamente en grupo A1: estrés agudo 1 hora; grupo A2: estrés agudo 1 hora + estímulo masticatorio 1 hora; grupo B1: estrés agudo 2 horas; grupo B2: estrés agudo 2 horas + estímulo masticatorio 2 horas; grupo C1: estrés agudo 3 horas; grupo C2: estrés agudo 3 horas + estímulo masticatorio 3 horas; y grupo D: sin intervención. Durante 3 días, se evaluó la memoria y el aprendizaje espacial en el laberinto acuático de Morris. La IL-6 fue determinada mediante ELISA. Resultados. La IL-6 fue mayor en el grupo B2 vs los demás grupos (p < 0,001). Además, en el primer día de evaluación, la adquisición de memoria y aprendizaje espacial fue menor en el grupo A1 vs A2 (p = 0,042). Conclusión. Solo en el primer día de evaluación encontramos que el estímulo masticatorio previno la disminución de la adquisición de memoria y aprendizaje espacial en ratones sometidos a estrés agudo de baja intensidad. Los resultados en general no fueron concluyentes sobre el efecto del estímulo masticatorio. Además, la IL-6 fue mayor en el estrés + el estímulo masticatorio (grupo B2) sobre el resto.

Introduction. Acute stress alters memory and spatial learning and the expression of interleukin 6, the chewing stimulus would prevent these effects. Objective. To determine the effect of chewing stimulation and acute stress on the expression of interleukin 6 and memory and spatial learning in mice. Methods. Experiment where 70 male albino mice of the Balb/c of age 2 month were randomly distributed into: Group A1: acute stress 1 hour; Group A2: acute stress 1 hour + chewing stimulus 1 hour; Group B1: acute stress 2 hours; Group B2: acute stress 2 hours + chewing stimulus 2 hours; Group C1: acute stress 3 hours; C2: acute stress 3 hours + chewing stimulus 3 hours; Group D: without intervention. For 3 days, spatial memory and learning were tested in the Morris water maze. Interleukin 6 (IL-6) was analyzed by ELISA test. Results. IL-6 was higher in the B2 group vs the other groups (p<0.0001). In addition, on the first day of evaluation, the acquisition of spatial memory and spatial was lower in the A1 vs. A2 group (p=0.042). Conclusión. Only on the first day of evaluation, we found that the masticatory stimulus prevented the decrease in memory acquisition and spatial learning in mice subjected to low-intensity acute stress. The results were generally inconclusive on the effect of masticatory stimulation. In addition, IL-6 was higher in the stress + masticatory stimulus (group B2) over the rest.

Stress hyperglycemia ratio predicts the outcome of successful recanalization after endovascular treatment in patients with acute ischemic stroke / 国际脑血管病杂志

Objective:To investigate the correlation between stress hyperglycemia ratio (SHR) and poor outcome of successful recanalization after endovascular treatment in patients with acute ischemic stroke.Methods:From January 2019 to October 2022, patients with acute ischemic stroke received endovascular treatment and successful recanalization in the Second People’s Hospital of Lianyungang were included retrospectively. SHR was defined as the fasting blood sugar and glycosylated hemoglobin ratio. At 90 d after procedure, the outcome of patients was evaluated using the modified Rankin Scale score. 0-3 was defined as good outcome, and >3 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent risk factor for poor outcome. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of SHR for 90 d poor outcome in patients with successful recanalization after endovascular treatment.Results:A total of 159 patients were enrolled, including 98 males (61.6%), aged 69.8±8.9 years old. The baseline National Institutes of Health Stroke Scale (NIHSS) score was 12.6±4.3, and SHR was 1.17±0.46. One hundred and five patients (66.0%) had good outcome, while 54 (34.0%) had poor outcome. There were statistically significant differences in SHR, fasting blood glucose, glycosylated hemoglobin, baseline NIHSS score and the proportion of patients with poor collateral circulation and symptomatic intracranial hemorrhage between the poor outcome group and the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that SHR was an independent predictor of poor outcome (odds ratio 2.254, 95% confidence interval 1.136-4.278; P<0.001). The ROC curve analysis showed that the area under the curve of SHR for predicting poor outcome was 0.726 (95% confidence interval 0.648-0.804; P<0.001), which was higher than fasting blood glucose and glycosylated hemoglobin. The optimal cutoff value for SHR was 1.21, and the sensitivity and specificity for predicting poor outcomes were 66.23% and 75.82%, respectively. Conclusion:SHR is associated with the poor outcome of successful recanalization after endovascular treatment in patients with acute ischemic stroke and can be used as a potential predictor.

Estrés académico en estudiantes de Enfermería durante la pandemia: retos, afrontamientos, perspectivas inmediatas / Academic stress in Nursing students during the pandemic: challenges, coping, immediate perspectives

Introducción: la COVID-19 ha sido un reto considerable para obtener una formación de elevada calidad para los discentes del área de Enfermería porque las universidades continuaban con normas, estrategias anticuadas que no respondían a los cambios. Objetivo: exponer los elementos teóricos relacionados con el estrés académico en los estudiantes de Enfermería, el afrontamiento durante el proceso enseñanza aprendizaje en tiempos de pandemia de COVID-19 y cuáles han sido las estrategias llevadas a cabo por las instituciones de educación superior. Métodos: se realizó una revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo sobre el contenido de las bibliografías, con una búsqueda documental basada en los 32 artículos científicos originales previamente seleccionados, publicaciones en idioma inglés, español y portugués en las bases de datos Scopus, Pubmed, Dialnet, Scielo, Elsevier, Latindex y Web of Science. Las palabras claves utilizadas fueron: estrés, academia, resiliencia, pandemia y enseñanza virtual. Desarrollo: el cambio del entorno presencial al virtual provocó un viraje significativo en el desarrollo del modo de enseñanza aprendizaje generando estrés, por lo que se deben manejar protocolos de atención para los estudiantes. Conclusiones: la academia fue sorprendida por la pandemia, como sucedió con la población en general. No se articularon suficientes estrategias para poder enfrentar las diferentes situaciones que generaron el estrés académico. Es necesario abordar la resiliencia para todas las eventualidades de salud.

Introduction: COVID-19 has been a considerable challenge to obtain high-quality training for students in the Nursing area because universities continued with norms, outdated strategies that did not respond to changes. Objective: to analyse the characteristics of academic stress in Nursing students during the teaching-learning process in times of the COVID-19 pandemic. Methods: a systematic bibliographic review was carried out to develop a reflective critical analysis on the content of the bibliographies, with a documentary search based on the 32 previously selected original scientific articles, publications in English, Spanish and Portuguese in the Scopus databases, Pubmed, Dialnet, Scielo, Elsevier, Latindex, and Web of Science. The keywords used were stress, academy, resilience, pandemic, and virtual teaching. Development: the change from the face-to-face to the virtual environment caused a significant shift in the development of the teaching-learning mode, generating stress, for which reason care protocols for students must be managed. Conclusions: the academy was surprised by the pandemic, as it happened with the general population. Not enough strategies were articulated to be able to face the different situations that generated academic stress. Resilience needs to be addressed for all health eventualities.

Analysis of the relationship between perceived stress level and death anxiety in individuals with COPD / Análisis de la relación entre el nivel de estrés percibido y la ansiedad por la muerte en individuos con EPOC

ABSTRACT Objectives: The study aimed to investigate the relationship between perceived stress level and death anxiety in individuals with COPD. Method: It was planned with a descriptive and relational screening design. It was carried out with the participation of 132 patients diagnosed with COPD. The study data were collected through Patient Information Form, Perceived Stress Scale, and Death Anxiety Scale. Descriptive statistics and multiple regression analysis were used in data analysis. Results: The COPD patients' total perceived stress scale and perceived insufficient self-efficacy and perceived stress/distress subscale mean scores were found as 32.75 ± 5.32, 15.81 ± 3.60, and 16.93 ± 2.97, respectively. The patients' Anxiety total scale mean score was determined to be 6.96 ± 3.40. A positive and statistically significant relationship was found between COPD patients' Perceived Stress total scale mean score and their Death Anxiety Scale mean score (F = 4.332, p < 0.05). Conclusion: Perceived stress level of COPD patients was found to be at a high level, while their death anxiety level was determined as moderate. It was also determined that as perceived stress levels of the patients increased, their death anxiety levels also increased.

RESUMEN Objetivos: Investigar la relación entre el nivel de estrés percibido y la ansiedad ante la muerte en personas con EPOC. Método: Se planificó con un diseño de screening descriptivo y relacional. En el estudio participaron 132 pacientes diagnosticados de EPOC. Los datos del estudio se recopilaron mediante el Formulario de información del paciente, la Escala de estrés percibido y la Escala de ansiedad ante la muerte. En el análisis de datos se utilizaron estadísticas descriptivas y análisis de regresión múltiple. Resultados: Las puntuaciones medias de la escala total de estrés percibido de los pacientes con EPOC y de la autoeficacia percibida insuficiente y de la subescala de estrés/angustia percibida fueron 32.75±5.32, 15.81±3.60 y 16.93±2.97 respectivamente. Se determinó que la puntuación media de la escala total de Ansiedad de los pacientes era 6.96 ± 3.40. Se encontró una relación positiva y estadísticamente significativa entre la puntuación media de la escala total de Estrés Percibido de los pacientes con EPOC y la puntuación media de la Escala de Ansiedad ante la Muerte (F = 4.332, p <0.05). Conclusión: Se descubrió que el nivel de estrés percibido por los pacientes con EPOC era alto, mientras que se determinó que su nivel de ansiedad ante la muerte era moderado. También se determinó que a medida que aumentaban los niveles de estrés percibido de los pacientes, también aumentaban sus niveles de ansiedad ante la muerte.

RESUMO Objetivos: Objetivou-se investigar a relação entre nível de estresse percebido e ansiedade de morte em indivíduos com DPOC. Método: Foi planejado com design de triagem descritiva e relacional. Foi realizado com a participação de 132 pacientes diagnosticados com DPOC. Os dados do estudo foram coletados por meio da Ficha de Informações do Paciente, da Escala de Estresse Percebido e da Escala de Ansiedade de Morte. Estatísticas descritivas e análises de regressão múltipla foram utilizadas na análise dos dados. Resultados: Os escores médios da escala total de estresse percebido e autoeficácia percebida insuficiente e estresse/angústia percebida dos pacientes com DPOC foram de 32.75 ± 5.32, 15.81 ± 3.60 e 16.93 ± 2.97, respectivamente. A pontuação média da escala total de ansiedade dos pacientes foi determinada em 6.96±3.40. Foi encontrada uma relação positiva e estatisticamente significativa entre a pontuação média da escala total de Estresse Percebido dos pacientes com DPOC e a pontuação média da Escala de Ansiedade da Morte (F = 4.332, p < 0.05). Conclusão: O nível de estresse percebido dos pacientes com DPOC foi considerado alto, enquanto o nível de ansiedade de morte foi considerado moderado. Também foi determinado que, à medida que os níveis de estresse percebidos pelos pacientes aumentavam, os níveis de ansiedade de morte também aumentavam.

Are Stress Associated with Temporomandibular Dysfunction? A Cross-Sectional Study / O Estresse Está Associado à Disfunção Temporomandibular? Um Estudo Transversal

Temporomandibular disorders are frequent in different segments of the population and harm the quality of life of individuals. The present sudy aimed to investigate the association between stress and temporomandibular dysfunction (TMD) in university students in Brazil. All incoming students at the Federal University of Pelotas were invited to participate in this cross-sectional study. A self-administered questionnaire was used with socioeconomic and oral health variables. TMD Fonseca questionnaire "Fonseca's anamnestic index" was used to identify the severity of symptoms of temporomandibular dysfunction. The same was elaborated in the form of Helkimo's anamnestic index. Stress was measured using a modified version of the Perceived Stress Scale and categorized into quartiles. Logistic multivariable regression models were used to analyze the associations of interest controlling for possible confounding variables. A backward stepwise procedure was used to select variables that should be kept in the final model. A total of 2,089 students answered the questionnaires and 82 (3.9%) were classified with the presence of TMD. Adjusted logistic regression shows that chance of presenting temporomandibular dysfunction was higher (OR=2.43; 95%CI=1.04-5.65) when the stress level increased. In conclusion, the mild degree of temporomandibular dysfunction was the most prevalent. Stress was associated with individuals with a higher prevalence of temporomandibular dysfunction. (AU)

As disfunções temporomandibulares são frequentes em diferentes segmentos da população e prejudicam a qualidade de vida dos indivíduos. O presente estudo teve como objetivo investigar a associação entre estresse e disfunção temporomandibular (DTM) em estudantes universitários no Brasil. Todos os alunos ingressantes da Universidade Federal de Pelotas foram convidados a participar deste estudo transversal. Foi utilizado um questionário autoaplicável com variáveis ​​socioeconômicas e de saúde bucal. O questionário TMD Fonseca "Índice anamnésico de Fonseca" foi utilizado para identificar a gravidade dos sintomas da disfunção temporomandibular. O mesmo foi elaborado na forma de índice anamnésico de Helkimo. O estresse foi medido usando uma versão modificada da Perceived Stress Scale e categorizado em quartis. Modelos de regressão logística multivariada foram usados ​​para analisar as associações de interesse controlando possíveis variáveis ​​de confusão. Um procedimento de backward stepwise foi usado para selecionar as variáveis ​​que deveriam ser mantidas no modelo final. Um total de 2.089 alunos responderam aos questionários e 82 (3,9%) foram classificados com presença de DTM. A regressão logística ajustada mostra que a chance de apresentar disfunção temporomandibular foi maior (OR=2,43; IC95%=1,04-5,65) quando o nível de estresse aumentou. Em conclusão, o grau leve de disfunção temporomandibular foi o mais prevalente. O estresse foi associado a indivíduos com maior prevalência de disfunção temporomandibular. (AU)

Effect of blood glucose on early neurological deterioration and outcome in patients with acute ischemic stroke after intravenous thrombolytic therapy / 国际脑血管病杂志

Objective:To investigate effect of blood glucose on early neurological deterioration (END) and outcome after intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods:Patients with AIS treated with intravenous thrombolysis in the Department of Neurology, the Second Affiliated Hospital of Xuzhou Medical University from June 2020 to December 2021 were collected retrospectively. Demographic and baseline clinical data of the patients were collected. END was defined as an increase of ≥2 in reassessing the maximum score of the National Institutes of Health Stroke Scale within 72 h after admission compared with the baseline. Poor outcome was defined as the modified Rankin Scale score ≥3 at 3 months after onset. Multivariate logistic regression analysis was used to evaluate the independent correlation between various blood glucose indicators (including admission blood glucose [ABG], admission hyperglycemia [AH], fasting blood glucose [FBG] on the next day after admission, and stress hyperglycemia ratio [SHR]) and END and poor outcome after intravenous thrombolysis. Results:A total of 319 patients with AIS were enrolled, including 126 (39.5%) had AH, 67 (21.0%) had END, and 85 (26.6%) had poor outcomes at 3 months after onset. Multivariate logistic regression analysis showed that after adjusting for confounding factors, ABG (odds ratio [ OR] 1.188, 95% confidence interval [ CI] 1.105-1.278; P<0.001), AH ( OR 4.246, 95% CI 2.291-7.869; P<0.001), FBG ( OR 1.272, 95% CI 1.139-1.420; P<0.001), and SHR ( OR 2.559, 95% CI 1.192-5.664; P=0.016) were independently associated with END, while all blood glucose indicators were not independently associated with the poor outcomes at 3 months after onset. Conclusion:Higher blood glucose is independently associated with END after intravenous thrombolysis in patients with AIS, but not with the outcomes at 3 months after onset.

The Effect of Perceived Stress and Digital Literacy on Student Satisfaction with Distance Education / O efeito do estresse percebido e do letramento digital na satisfação do aluno quanto à educação a distância / El efecto del estrés percibido y la alfabetización digital en la satisfacción de los estudiantes en educación a distancia

ABSTRACT Objective: To examine the relationship between perceived stress/digital literacy and student satisfaction in health science college students in the distance education process. Method: The cross-sectional study was conducted by collecting data from 842 students. The dependent variable was student satisfaction in distance education. For the analyses, t-test, ANOVA (post hoc: Bonferroni), and linear regression methods were used. Results: Distance education student satisfaction was 178.21 ± 48.64. Student satisfaction was low among those who think that distance education is not more effective than face-to-face education, live in villages/towns, and have high perceived stress. Student satisfaction was high among those who do not have limited internet access, can access the internet via computer, follow the lessons regularly every week, think distance education is applicable in the health domain, can acquire instant feedback from the instructor, and have increased digital literacy. Conclusion: Distance education student satisfaction was found to be moderate. Student satisfaction in distance education increases as perceived stress levels decrease and digital literacy levels increase.

RESUMO Objetivo: Examinar a relação entre estresse percebido e letramento digital com a satisfação de alunos de faculdades de ciências da saúde no processo de educação a distância. Método: O estudo transversal foi realizado por meio da coleta de dados de 842 alunos. A variável dependente foi a satisfação dos alunos na educação a distância. Para as análises, foram utilizados os métodos de teste t, ANOVA (post hoc: Bonferroni) e regressão linear. Resultados: A satisfação dos alunos de educação a distância foi de 178,21 ± 48,64. A satisfação dos alunos foi baixa entre aqueles que pensam que a educação a distância não é mais eficaz do que a educação presencial, que moram em vilas/cidades e apresentam alto estresse percebido. A satisfação dos alunos foi alta entre aqueles que não têm acesso limitado à internet, podem acessar a internet pelo computador, acompanhar as aulas regularmente toda semana, acham que a educação a distância é aplicável no domínio da saúde, podem adquirir feedback instantâneo do instrutor e têm maior letramento digital. Conclusão A satisfação dos alunos de educação a distância foi considerada moderada. A satisfação dos alunos na educação a distância aumenta à medida que os níveis de estresse percebido diminuem e os níveis de letramento digital aumentam.

RESUMEN Objetivo: Examinar la relación entre el estrés percibido y la alfabetización digital con la satisfacción de los estudiantes de la facultad de ciencias de la salud en el proceso de educación a distancia. Método: El estudio transversal se realizó mediante la recopilación de datos de 842 estudiantes. La variable dependiente fue la satisfacción de los estudiantes en educación a distancia. Para los análisis, se utilizaron métodos de prueba t, ANOVA (post hoc: Bonferroni) y regresión lineal. Resultados: La satisfacción de los estudiantes de educación a distancia fue de 178,21 ± 48,64. La satisfacción de los estudiantes fue baja entre aquellos que piensan que la educación a distancia no es más efectiva que la educación presencial, los que viven en aldeas/pueblos y con un alto nivel de estrés percibido. La satisfacción de los estudiantes fue alta entre aquellos que no tienen acceso limitado a Internet, pueden acceder a Internet a través de una computadora, siguen las lecciones con regularidad todas las semanas, piensan que la educación a distancia es aplicable en el ámbito de la salud, pueden obtener retroalimentación instantánea del instructor y tienen un mayor conocimiento de alfabetización digital. Conclusión: Se encontró que la satisfacción de los estudiantes de educación a distancia es moderada. La satisfacción de los estudiantes en la educación a distancia aumenta a medida que disminuyen los niveles de estrés percibido y aumentan los niveles de alfabetización digital.

Intensive care unit prescriptions must fit risk factors to prevent stress ulcer bleeding / Prescrições em unidade de terapia intensiva devem adequar-se aos fatores de risco na prevenção de sangramento por úlcera de estresse

ABSTRACT Background: The physiological stress of critically ill patients can trigger several complications, including digestive bleeding due to stress ulcers (DBSU). The use of acid secretion suppressants to reduce their incidence has become widely used, but with the current understanding of the risks of these drugs, their use, as prophylaxis in critically ill patients, is limited to the patients with established risk factors. Aim: To determine the appropriateness of the use of prophylaxis for stress ulcer bleeding in acutely ill patients admitted to intensive care units and to analyze the association of risk factors with adherence to the prophylaxis guideline. Methods: Retrospective, analytical study carried out in three general adult intensive care units. Electronic medical records were analyzed for epidemiological data, risk factors for DBSU, use of stress ulcer prophylaxis, occurrence of any digestive bleeding and confirmed DBSU. The daily analysis of risk factors and prophylaxis use were in accordance with criteria based on the Guidelines of the Portuguese Society of Intensive Care for stress ulcer prophylaxis. Results: One hundred and five patients were included. Of the patient days with the opportunity to prescribe prophylaxis, compliance was observed in 95.1%. Of the prescription days, 82.35% were considered to be of appropriate use. Overt digestive bleeding occurred in 3.81% of those included. The occurrence of confirmed DBSU was identified at 0.95%. Multivariate analysis by logistic regression did not identify risk factors independently associated with adherence to the guideline, but identified risk factors with a negative association, which were spinal cord injury (OR 0.02 p <0.01) and shock (OR 0.36 p=0.024). Conclusion: The present study showed a high rate of adherence to stress ulcer prophylaxis, but with inappropriate use still significant. In the indication of prophylaxis, attention should be paid to patients with spinal cord injury and in shock.

RESUMO Racional: O estresse fisiológico dos pacientes críticos pode desencadear várias complicações, entre elas o sangramento digestivo por úlcera de estresse (SDUE). O uso de supressores da secreção ácida para reduzir sua incidência passou a ser amplamente utilizado, mas com o atual entendimento dos riscos destes medicamentos sua utilização, como profilaxia em doentes críticos, está limitada aos pacientes com fatores de risco estabelecidos. Objetivos: Determinar a adequação do uso de profilaxia para sangramento por úlcera de estresse em pacientes agudamente enfermos internados em unidades de terapia intensiva e analisar a associação dos fatores de risco com a adesão à diretriz de profilaxia. Métodos: Estudo retrospectivo, analítico, realizado em três unidades de terapia intensiva gerais de adultos. Os prontuários eletrônicos foram analisados para dados epidemiológicos, fatores de risco para SDUE, uso de profilaxia para SDUE, ocorrência de qualquer sangramento digestivo e de SDUE confirmado. A análise diária dos fatores de risco e uso de profilaxia foram de acordo com critérios baseados nas Diretrizes da Sociedade Portuguesa de Cuidados Intensivos para profilaxia da úlcera de estresse. Resultados: foram incluídos 105 pacientes. Dos pacientes-dia com oportunidade de prescrição de profilaxia, foi observada adesão em 95,1%. Dos dias de prescrição foram considerados de uso apropriado 82,35%. Sangramento digestivo visível ocorreu em 3,81% dos incluídos. A ocorrência de SDUE confirmado foi identificada em 0,95%. A análise multivariada por regressão logística não identificou fatores de risco independentemente associados com a adesão à diretriz, mas identificou fatores de risco com associação negativa, que foram lesão da medula espinhal (OR 0.02 p<0,01) e choque (OR 0.36 p=0.024). Conclusão: O presente estudo evidenciou alta taxa de adesão à profilaxia para SDUE, mas com uso inapropriado ainda significativo. Na indicação de profilaxia deve-se ter atenção aos pacientes com lesão de medula espinhal e choque.

Efeito da música como recurso terapêutico em grupo de convivência para pessoas idosas / Effect of music as a therapeutic resource in a support group for the elderly

RESUMO Objetivo analisar o efeito de intervenções musicais na redução dos níveis de estresse em pessoas idosas. Métodos pesquisa quantitativa, do tipo quase-experimental, em que se avaliou o nível de estresse antes e depois de intervenções com música, com o método musicoterápico, denominado experiência receptiva, em 25 pessoas idosas de um grupo de convivência. Utilizou-se da Escala de Estresse Percebido e realizou-se a análise estatística descritiva e inferencial. Resultados na avaliação do estresse percebido, a média foi de 33,6 (Desvio-padrão 5,17) pontos no pré-teste e 31,6 (Desvio-padrão 2,29) pontos no pós-teste (p<0,05). Na avaliação por dimensão, a redução na pontuação foi identificada apenas no fator perceived distress. Identificou-se, no pré-teste, que quanto maior a renda mensal, menor o estresse percebido (p=0,043). Conclusão intervenções musicais com os participantes deste estudo foram capazes de reduzir os níveis de estresse, indicando a validade da música como recurso terapêutico em ações de promoção à saúde.

ABSTRACT Objective to analyze the effect of musical interventions to reduce stress levels in the elderly. Methods quantitative research, of quasi-experimental type, in which the level of stress was assessed before and after interventions with the music therapy method, called receptive experience, in 25 elderly people in a support group. The Perceived Stress Scale was used and descriptive and inferential statistical analysis was performed. Results in the assessment of perceived stress, the average was 33.6 (standard deviation 5.17) points in the pre-test and 31.6 (standard deviation 2.29) points in the post-test (p<0.05). In the assessment dimension, the reduction was identified only in the perceived distress factor. Pre-tests outcomes showed that the higher the monthly income, the lower the perceived stress (p=0.043). Conclusion musical interventions with the participants of this study were able to reduce stress levels, indicating the importance of music as a therapeutic resource in health promotion actions.

Estresse discente em um curso de Fonoaudiologia / Student stress in a speech, language and hearing sciences undergraduate course

RESUMO Objetivo verificar a prevalência de estresse e os fatores associados à sua presença em discentes de um curso de Fonoaudiologia. Métodos participaram 105 discentes, maiores de 18 anos, de ambos os sexos, matriculados no curso de Fonoaudiologia de uma universidade federal. Foram excluídos os discentes que não estavam com a matrícula ativa durante o período da pesquisa. Todos responderam a um questionário sociodemográfico e ao Inventário de Sintomatologia de Stress de Lippi, que identifica os sintomas de estresse, bem como a sua respectiva fase e os sintomas predominantes. Os dados receberam tratamento estatístico, sendo estipulado o nível de significância de 5%. Resultados dentre os participantes, 77,1% apresentaram resultados sugestivos de estresse, sendo que, destes, 77,7% estavam na fase de "resistência", 18,5% na fase de "quase exaustão"; 2,5% na fase de "alerta"; e 1,2% na fase de "exaustão". Quanto à sintomatologia 64,2% apresentaram predominância de sintomas psicológicos, 18,5%, físicos e 17,3%, físicos e psicológicos. A análise estatística mostrou a presença significativamente superior de estresse entre as mulheres e entre os que não trabalhavam e a relação do estresse com o ano de estudo. Conclusão um elevado número de discentes de Fonoaudiologia foi identificado com estresse, sendo a fase de "resistência" a mais frequente, com prevalência de sintomas psicológicos. Os fatores associados ao estresse foram sexo, com maior prejuízo entre as mulheres, o fato de não exercerem atividade remunerada e o ano do curso em que estavam matriculados, sendo que no primeiro ano foi observada menor prevalência de estresse e no último ano, maior.

ABSTRACT Objective To verify the prevalence and factors associated with the presence of stress in students of a Speech, Language, and Hearing Sciences course. Methods 105 students participated, over 18 years old, of both sexes, enrolled in the Speech, Language and Hearing Sciences course at a Federal University. Students who were not active during participation in the research were excluded. All respond to a sociodemographic questionnaire and Lipp's Stress Symptoms Inventory, which identifies the symptoms of stress, as well as their s—pecific phase and the predominant symptoms. The data received statistical treatment being stipulated the significance level of 5%. Results 77.1% showed results suggestive of stress, of which 77.7% were in the "resistance" phase, 18.5% in the "almost exhaustion"; 2.5% in the "alarm"; and 1.2% in the "exhaustion". As for the symptomatology, 64.2% had a predominance of psychological symptoms, 18.5% physical, and 17.3% physical and psychological. The statistical analysis showed a significantly higher presence of stress among women and among those who do not work, and a relationship between stress and the study year. Conclusion A high number of Speech, Language and Hearing Sciences students with stress, was identified, with the "resistance" phase as the most frequent and the prevalence of psychological symptoms. The factors associated with stress were gender, which presented greater damages among women, the fact that students do not engage in paid work, and the year of the course they were enrolled. The first year had the lowest prevalence of stress, while the last year had the highest result.

Estrés académico y estrategias de afrontamiento en estudiantes de carreras de salud de Santiago de Chile / Academic stress and coping strategies in students of health degrees in Santiago de Chile

RESUMEN Fundamento: el stress académico en los estudiantes universitarios puede desencadenar manifestaciones en el orden físico, psicológico y social. Objetivo: determinar el estrés académico y las estrategias de afrontamiento en estudiantes de carreras de salud en Santiago de Chile. Métodos: se realizó un estudio transversal-analítico en una institución de educación superior privada de Santiago de Chile durante el año 2019. Se emplearon los instrumentos de Estrés Académico modificado y la Escala de Afrontamiento del Estrés Académico a la muestra de estudiantes. Se utilizó estadística descriptiva e inferencial, utilizando ANOVA (one-way), test de posthoc de Tukey y Chi2. La significancia se estableció en α<0,05 y los análisis se realizaron con el software STATA 15.0. Resultados: más del 70 % de la muestra se encontraba en un nivel socioeconómico medio-bajo. La situación generadora de estrés predominante estuvo referida a la sobrecarga de trabajo, la cual fue diferente entre los estudiantes de Enfermería (4,1±0,7) en comparación con los de las otras carreras (p=0,032). Ellos presentaron principalmente reacciones físicas ante las situaciones del estrés académico (p=0,024) mientras que los de Terapia Ocupacional tuvieron mayormente reacciones psicológicas (p=0,21). Estos últimos refirieron la revaluación positiva como estrategia de afrontamiento, mientras que el resto de las carreras prefieren la búsqueda de apoyo (p=0.032). Conclusiones: se determinó el estrés académico y sus estrategias de afrontamiento en estudiantes de carreras de salud en Santiago de Chile, quienes identificaron la sobrecarga de trabajo como su génesis sin presentar diferencias entre programas de estudio, pero sí en su afrontamiento.

ABSTRACT Background: academic stress in university students can trigger manifestations in the physical, psychological and social order. Objective: to determine academic stress and coping strategies in students of health degrees in Santiago de Chile. Methods: a cross-sectional-analytical study was carried out in a private higher education institution in Santiago de Chile during 2019. The modified Academic Stress instruments and the Academic Stress Coping Scale were applied to the sample of students. Descriptive and inferential statistics were used, using ANOVA (one-way), Tukey's posthoc test and Chi2. Significance was established at α <0.05 and analyzes were performed with the STATA 15.0 software. Resultados: más del 70 % de la muestra se encontraba en un nivel socioeconómico medio-bajo. La situación generadora de estrés predominante estuvo referida a la sobrecarga de trabajo, la cual fue diferente entre los estudiantes de Enfermería (4,1±0,7) en comparación con los de las otras carreras (p=0,032). Ellos presentaron principalmente reacciones físicas ante las situaciones del estrés académico (p=0,024) mientras que los estudiantes Terapia Ocupacional tuvieron principalmente reacciones psicológicas (p=0,21). Estos últimos refirieron la revaluación positiva como estrategia de afrontamiento, mientras que el resto de las carreras prefieren la búsqueda de apoyo (p=0.032). Conclusiones: se determinó el estrés académico y sus estrategias de afrontamiento en estudiantes de carreras de salud en Santiago de Chile, quienes identificaron la sobrecarga de trabajo como su génesis sin presentar diferencias entre programas de estudio, pero sí en su enfrentamiento.

Estrés en estudiantes de enfermería que realizan prácticas clínicas en una institución universitaria de Cartagena-Colombia, 2019 / Stress in nursing students who carry out clinical practices in a university institution of Cartagena-Colombia, 2019

Objetivo: determinar los niveles de estrés que experimentan los estudiantes de enfermería que realizan sus prácticas clínicas en una institución universitaria de la ciudad de Cartagena (Colombia). Materiales y métodos: se realizó un estudio descriptivo, transversal, con una muestra de 98 estudiantes de enfermería matriculados en semestres de IV a IX. Se aplicó cuestionario KEZKAK sobre percepción de estrés en estudiantes de enfermería en prácticas clínicas. Los análisis emplearon estadística descriptiva. Resultados: los estudiantes tuvieron edades comprendidas entre 20 ­ 24 años (61,2%), fueron mujeres (93,9%). Presentaron nivel alto de estrés (51%), durante las prácticas clínicas por considerar falta de competencias (68,4%), impotencia e incertidumbre, y el enfermo busca una relación íntima y/o amorosa con 48% respectivamente. Conclusiones: los estudiantes evidencian que la falta de competencias al brindar cuidado a los pacientes en situaciones críticas, se convierte en un determinante generador de estrés..Au

Objective: to determine the levels of stress experienced by nursing students who carry out their clinical practices in a university institution in the city of Cartagena (Colombia).Materials and methods: a descriptive, cross-sectional study was carried out.With a sample of 98 Nursing students enrolled in semesters from IV to IX. A KEZKAK questionnaire on the perception of stress in nursing students in clinical practices was applied. The analyzes were performed using descriptive statistics. Results: the students were aged 20-24 years (61.2%), were women (93.9%).They presented a high level of stress (51%), during clinical practices because they considered lack of skills (68.4%) impotence and uncertainty, and the patient seeks an intimate and / or loving relationship with 48%, respectively. Conclusions: students show that the lack of skills in providing care to patients in critical situations becomes a determinant of stress..Au

Prácticas de ansiólisis preoperatoria en pacientes pediátricos: prevalencia, limitantes y otros factores relacionados / Preoperative anxiolysis practices in pediatric patients: prevalence, limitations and other related factors

Resumen: Introducción: La ansiedad perioperatoria en niños se asocia con desenlaces postoperatorios como pesadillas, caminar nocturno, enuresis de nueva aparición, terrores nocturnos, episodios de irritabilidad inadecuada y trastorno de ansiedad por separación. La ansiólisis perioperatoria permite disminuir la generación de esos desenlaces; sin embargo, su prevalencia es desconocida en Colombia. Objetivo: Describir la práctica de ansiólisis perioperatoria en población pediátrica, llevada a cabo por anestesiólogos en Colombia. Material y métodos: Se realizó un estudio descriptivo, mediante encuestas electrónicas autodiligenciadas se exploraron variables demográficas, conocimientos, actitudes y prácticas sobre la conducta y la prevención de la ansiedad perioperatoria en niños. Se excluyeron registros incompletos para el análisis de variables asociadas y se realizó un análisis de sensibilidad para determinar el impacto de la exclusión de respuestas incompletas en los resultados. El envío de las encuestas estuvo a cargo de la Sociedad Colombiana de Anestesiología. Resultados: Se obtuvieron 220 encuestas completas, en su mayoría de Bogotá, Valle del Cauca y Antioquia. La prevalencia de ansiólisis perioperatoria fue de 86.8%, su práctica no se relacionó con la presencia de formación de subespecialidad. Limitantes como «falta de fomento institucional¼ (p = 0.000 OR = 1.69), «no disponibilidad de fármacos ansiolíticos ideales¼ (p = 0.000 OR = 3.52) y «temor a los eventos adversos asociados con algunos fármacos ansiolíticos¼ (p = 0.013 OR = 5.47) se relacionaron con la no realización de ansiólisis perioperatoria en niños, así como un menor puntaje. Conclusión: Existen diferentes factores, que limitan la realización de ansiólisis perioperatoria en niños, potencialmente modificables con políticas nacionales, institucionales y profesionales.

Abstract. Introduction: Perioperative anxiety in children is associated with postoperative outcomes such as, nightmares, sleep-walking, new onset enuresis, night terrors, separation anxiety disorder and tantrums. Perioperative anxiolysis allows to diminish the presentation of these outcomes, however, it's prevalence its unknown in Colombia. Aim: To describe the practice of perioperative anxiolysis in pediatric populations, carried out by Colombian anesthesiologists. Material and methods: A descriptive study was carried out, self-completed electronic surveys explored demographic variables, knowledge, attitudes and practices about management and prevention of perioperative anxiety in children. Incomplete records were excluded for analysis. A sensitivity analysis was done to determine the impact of the exclusion of incomplete records. Colombian Anesthesiology Society was in charge of sending the surveys. Results: Two-hundred and twenty (220) complete records were obtained, mostly from Bogotá, Valle del Cauca and Antioquia. The prevalence of perioperative anxiolysis was 86.8%, its practice was not related with any subspecialty. Barriers such as «Lack of institutional promotion¼ (p = 0.000 OR = 1.69), «Unavailability of ideal anxiolytic medicines¼ (p = 0.000 OR = 3.52) and «Fear of drug-related adverse reactions¼ (p = 0.013 OR = 5.47) were identified in multivariate analysis. Conclusion: Different factors limit the execution of perioperative anxiolysis in children, all of them potentially modifiable with national, institutional and professional policies.