Influence of preoperative emotional state on postoperative pain following orthopedic and trauma surgery / Influência do estado emocional pré-operatório na dor pós-operatória após cirurgias ortopédicas e traumatológicas / Influencia del estado emocional prequirúrgico en el dolor postoperatorio tras cirugía ortopédica y traumatológica

OBJECTIVES: to analyze the relationship between preoperative emotional state and the prevalence and intensity of postoperative pain and to explore predictors of postoperative pain. METHOD: observational retrospective study undertaken among 127 adult patients of orthopedic and trauma surgery. Postoperative pain was assessed with the verbal numeric scale and with five variables of emotional state: anxiety, sweating, stress, fear, and crying. The Chi-squared test, Student's t test or ANOVA and a multivariate logistic regression analysis were used for the statistical analysis. RESULTS: the prevalence of immediate postoperative pain was 28%. Anxiety was the most common emotional factor (72%) and a predictive risk factor for moderate to severe postoperative pain (OR: 4.60, 95% CI 1.38 to 15.3, p<0.05, AUC: 0.72, 95% CI: 0.62 to 0.83). Age exerted a protective effect (OR 0.96, 95% CI: 0.94-0.99, p<0.01). CONCLUSION: preoperative anxiety and age are predictors of postoperative pain in patients undergoing orthopedic and trauma surgery. .

OBJETIVOS: analisar a relação entre o estado emocional pré-operatório e a prevalência e a intensidade da dor pós-operatória e explorar fatores preditivos de dor pós-operatória. MÉTODO: estudo retrospectivo observacional, realizado com 127 pacientes adultos submetidos a cirurgias ortopédicas e traumatológicas. A dor pós-operatória foi avaliada usando a escala numérica verbal e cinco variáveis do estado emocional: ansiedade, sudorese, estresse, medo e choro. Para a análise estatística, foram utilizados os testes do qui-quadrado, teste t de Student ou análise de variância e uma análise de regressão logística multivariada. RESULTADOS: a prevalência de dor pós-operatória imediata foi de 28%. A ansiedade foi o fator emocional mais comum (72%) e fator preditivo de risco para dor pós-operatória severa (OR: 4,60, IC 95%: 1,38 a 15,3, p<0,05, AUC: 0,72, IC 95%: 0,62 a 0,83). A idade exerceu efeito protetor (OR 0,96, IC 95%: 0,94-0,99, p<0,01). CONCLUSÃO: a ansiedade pré-operatória e a idade são fatores preditivos de dor pós-operatória em pacientes submetidos a cirurgias ortopédicas e traumatológicas. .

OBJETIVOS: analizar la relación entre el estado emocional preoperatorio y la prevalencia e intensidad de dolor postoperatorio inmediato y explorar los factores predictivos de dolor postoperatorio. MÉTODO: estudio observacional y retrospectivo realizado a 127 pacientes adultos de cirugía ortopédica y traumatológica. El dolor postoperatorio se evaluó con la escala verbal numérica y el estado emocional con 5 variables: ansiedad, sudor, tensión, miedo, lloros. Para el análisis estadístico se utilizaron las pruebas de χ2, t de Student o ANOVA y un análisis multivariado con regresión logística. RESULTADOS: la prevalencia de dolor postoperatorio inmediato fue del 28%. La ansiedad fue el factor emocional más frecuente (72%) y un factor de riesgo predictivo para el dolor postoperatorio moderado-intenso (OR: 4,60, IC95%: 1,38-15,3, p<0,05; AUC: 0,72, IC95%: 0,62-0,83). La edad ejercía un efecto protector (OR: 0,96; IC95%: 0,94-0,99, p<0.01). CONCLUSIÓN: la ansiedad prequirúrgica y la edad son factores predictivos del dolor postoperatorio en pacientes sometidos a cirugía ortopédica y traumatológica. .

Psychopathology and psychosocial adjustment in patients with HIV-associated lipodystrophy

OBJECTIVE: To study whether patients with HIV-1 associated lipodystrophy (LD) on highly active antiretroviral treatment (HAART) have more psychopathology and worse psychosocial adjustment than a similar group without this syndrome. METHODS: In a cross-sectional, observational study we compared 47 HIV-1 infected patients with LD (LD group) with 39 HIV-1 infected patients without LD (non-LD group). All participants were on HAART. The Beck Depression Inventory (BDI), the State and Trait Anxiety Inventory (STAI) and the Goldberg Health Questionnaire (GHQ-60) were administered. Levels of familial, work and social adjustment and adjustment to stressful events were evaluated in a semi-structured interview. Clinical information was extracted from the clinical records. RESULTS: In the univariate analysis patients with LD showed higher state anxiety scores (p = 0.009) and worse work adjustment (p = 0.019) than those without LD. A total of 45.3% of LD patients scored above the cut-off point on the trait anxiety scale, and over 33.3% scored above the cut-off point on the BDI, GHQ and state anxiety scales. However, in multivariate analyses LD was not independently associated with psychopathology or with worse adjustment in the studied areas. CONCLUSIONS: The finding that LD was not a predictor of greater psychopathology or worse psychosocial adjustment in HIV-1 infected patients, despite the high scores found, suggests that factors not taken into account in this study, such as LD severity and self-perception should have been included in the analysis. Further studies including a greater number of variables and a larger sample size will advance our understanding of this complex condition.

Bajo peso al nacer: exploración de algunos factores de riesgo en el Hospital Universitario San José en Popayán (Colombia) / Low birth weight: exploring of some risk factors at the San José teaching hospital in Popayán, Colombia

Introducción: el bajo peso al nacer (BPN) es un importante problema de salud pública en los países endesarrollo y es un indicador de la salud materno-infantil. El peso al nacer por debajo de 2.500 g contribuyea problemas de salud materno-infantiles de corto y largo plazo. Objetivo: establecer los factores asociados con el bajo peso al nacer en el Hospital Universitario San José, Popayán (Colombia), en el período comprendidoentre los años 2005 y 2006. Métodos y materiales: estudio de casos y controles. Los casos (n=344) fueron los recién nacidos con peso menor a 2.500 g que nacieron en este hospital.Los controles (n=483) fueron recién nacidos con peso mayor a 2.500 g que nacieron el mismo día. Se realizó una entrevista en mujeres despuésdel parto para recoger información acerca de losfactores de riesgo; y se estimó el Odds Ratio (OR, por sus siglas en inglés) y sus respectivos intervalosde confianza (IC95 por ciento) utilizando un modelo de regresión logística. Resultados: como factores de protección se consideraron: antecedentes de estrato socioeconómico medio/superior (OR=0,33; IC95 por ciento 0,12-0,91), sexo femenino del recién nacido (OR=0,73; IC95 por ciento 0,55-0,98), tener más de 5 controles prenatales (OR=0,54; IC95 por ciento 0,39-0,75) y no tener antecedentesprevios de BPN (OR=0,30; IC95 por ciento 0,15-0,58). Entre los factores de riesgo se encontraron: antecedentes de infecciones del tracto urinario (OR=1,78;IC95 por ciento 1,30-2,45) y cesárea anterior (OR=1,88; IC95 por ciento 1,13-3,16). Conclusión: el bajo peso al nacer está asociado con el estrato socioeconómico, por lo que intervenir en la falta de equidad social es un factor de importancia para la reducción del BPN en el área de influencia de este centro de atención terciaro

Introduction: low birth weight (LBW) is a major public health problem and maternal-infant health indicator in developing countries. A birth weightbelow 2.500 g contributes towards poor short- and long-term maternal-infant health outcomes. Objective: establishing risk factors for LBW in the San José teaching hospital in Popayán, Colombia, 2005-2006. Methods and materials: this was a case-control study. Cases (n=344) were newborn (<2.500 g) who had been born in this hospital; the controls (n=483) were newborn (>2.500 g) who were born on the same day. An interview was conducted to collect information regarding risk factors from post-partum females. A logistic regression modelwas used for estimating risk factors by Odds Ratio (OR) with confidence intervals (95 percent CI).Results: having a middle/upper socio-economic class background (OR=0,33; 95 percent CI 0,12-0,91), the newborn being female (OR=0,73; 95 percent CI 0,55-0,98), having had more than 5 prenatalcontrols (OR=0,54; 95 percent CI 0,39-0,75), having no background of previous LBW (OR=0,30; 95 percent CI 0,15-0,58) were protective factors for LBW. Havinga background of urinary tract infection (OR=1,78; 95 percent CI 1,30-2,45) and having undergone a previous caesarean section (OR=1,88; 95 percent CI 1,13-3,16)were low birth weight risk factors. Conclusion: LBW was thus seen to be associated with coming from a lower socio-economic class. Interventions regarding the lack of social equity istherefore an important factor in reducing LBW in this third-level hospital’s area of influence.