Human social isolation and stress: a systematic review of different contexts and recommendations for future studies

Abstract Objectives The emergence of the coronavirus disease 2019 (COVID-19) pandemic and subsequent lockdowns and social distancing measures adopted worldwide raised questions about the possible health effects of human social isolation. Methods We conducted a systematic review on PubMed, Scopus, and Embase electronic databases using terms related to human social isolation - defined as the isolation of an individual from regular routines and usual social contact - and psychological stress, searching for simulated or naturalistic isolation environments. We present the main results, as well as the validity and limitations of each model. PROSPERO registry number: CRD42021241880. Results Despite the diversity of contexts reviewed, some outcomes almost ubiquitously relate to psychological stress, i.e., longer periods, expectation of a longer period, confinement, lack of social interaction, and support. Based on the results, and considering that most studies were not designed for the purpose of understanding isolation itself, we propose a group of recommendations for future experimental or naturalistic research on the topic. Conclusion Evidence on the impact of different situations in which individuals are subjected to social isolation can assist in development of directed preventive strategies to support people under similar circumstances. Such strategies might increase the general public's compliance with social distancing as a non-pharmacological intervention for emerging infectious diseases.

Adaptation and validation of the Mood Rhythm Instrument for use in Brazilian adolescents

Objective: Adapt and validate the Mood Rhythm Instrument (MRhI), a self-reported questionnaire that assesses self-perceived rhythmicity of mood-related symptoms in adults, into a version that assesses and evaluates perceived mood-related symptoms in adolescents (MRhI-Y). Methods: Adaptation of the Brazilian Portuguese version of the MRhI for an adolescent population followed three steps: review by consultants, analysis by experts, and pilot testing through a visual analogue scale (VAS). The final questionnaire (MRhI-Y) was applied to 171 adolescents aged 12-17 years. Internal consistency was calculated using Cronbach's alpha and McDonald's omega. The psychometric properties of the MRhI-Y were evaluated using exploratory factor analysis (EFA). Results: The MRhI-Y was designed to use wording more appropriate for adolescents than that of the MRhI. Expert agreement about item quality ranged between 82 and 100%. Adolescents' VAS ratings indicated good comprehension of the items. Cronbach's alpha and McDonalds' omega coefficients were 0.71 and 0.74. The EFA resulted in a three-factor solution (affective, cognitive, and somatic). Younger adolescents (ages 12 to 13) reported lower rhythmicity scores than older groups (ages 14 to 15 and 16 to 17), even controlling for chronotype. Conclusions: The Brazilian Portuguese version of the MRhI-Y presented adequate comprehension by adolescents and good internal consistency. The MRhI-Y is a promising tool to improve our understanding of the underlying characteristics of mood fluctuation in adolescence.

Effective recommendations towards healthy routines to preserve mental health during the COVID-19 pandemic

Objective: To assess the adherence to a set of evidence-based recommendations to support mental health during the coronavirus disease 2019 (COVID-19) pandemic and its association with depressive and anxiety symptoms. Methods: A team of health workers and researchers prepared the recommendations, formatted into three volumes (1: COVID-19 prevention; 2: Healthy habits; 3: Biological clock and sleep). Participants were randomized to receive only Volume 1 (control), Volumes 1 and 2, Volumes 1 and 3, or all volumes. We used a convenience sample of Portuguese-speaking participants over age 18 years. An online survey consisting of sociodemographic and behavioral questionnaires and mental health instruments (Patient Health Questionnaire-9 [PHQ-9] and Generalized Anxiety Disorder-7 [GAD-7]) was administered. At 14 and 28 days later, participants were invited to complete follow-up surveys, which also included questions regarding adherence to the recommendations. A total of 409 participants completed the study - mostly young adult women holding university degrees. Results: The set of recommendations contained in Volumes 2 and 3 was effective in protecting mental health, as suggested by significant associations of adherence with PHQ-9 and GAD-7 scores (reflecting anxiety and depression symptoms, respectively). Conclusion: The recommendations developed in this study could be useful to prevent negative mental health effects in the context of the pandemic and beyond.

Translation and adaptation of the indoor environmental quality questionnaire to Brazilian portuguese

Introduction: Indoor environmental quality (IEQ) impacts well-being, performance, and mental and physical health. A questionnaire for assessing occupants' perception of IEQ was developed in English. This study aimed to translate this instrument into Brazilian Portuguese and adapt it to the Brazilian population.Methods: The translation and adaptation process consisted of forward translation, reconciliation, back translation, back translation review, harmonization, two cognitive debriefings, and finalization.Results: The final translated version included new questions and changed the scale to a visual-analog format. The clarity assessment showed that, after cognitive debriefings, all questions displayed satisfactory scores, with the majority rated higher than 9 on a 0-10 scale.Conclusions: The Brazilian Portuguese version of the IEQ questionnaire is a simple tool that can be employed in biomedical and building research to investigate the association of perceived IEQ with health-related parameters, as well as in architecture, engineering, and management projects. As a next step, a psychometric validation of the instrument will be performed.

How do stress, sleep quality, and chronotype associate with clinically significant depressive symptoms? A study of young male military recruits in compulsory service

Objective: Although studies have shown an association between poor sleep and chronotype with psychiatric problems in young adults, few have focused on identifying multiple concomitant risk factors. Methods: We assessed depressive symptoms (Beck Depression Inventory [BDI]), circadian typology (Morningness-Eveningness Questionnaire [MEQ]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), perceived stress (Perceived Stress Scale [PSS]), social rhythm (Social Rhythm Metrics [SRM]), and salivary cortisol (morning, evening and night, n=37) in 236 men (all 18 years old). Separate analyses were conducted to understand how each PSQI domain was associated with depressive symptoms. Results: Depressive symptoms were more prevalent in individuals with higher perceived stress (prevalence ratio [PR] = 6.429, p < 0.001), evening types (PR = 2.58, p < 0.001) and poor sleepers (PR = 1.808, p = 0.046). Multivariate modeling showed that these three variables were independently associated with depressive symptoms (all p < 0.05). The PSQI items subjective sleep quality and sleep disturbances were significantly more prevalent in individuals with depressive symptoms (PR = 2.210, p = 0.009 and PR = 2.198, p = 0.008). Lower levels of morning cortisol were significantly associated with higher depressive scores (r = -0.335; p = 0.043). Conclusion: It is important to evaluate multiple factors related to sleep and chronotype in youth depression studies, since this can provide important tools for comprehending and managing mental health problems.

Physical self-efficacy is associated to body mass index in schoolchildren / Autoeficácia física associada ao índice de massa corporal em crianças em idade escolar

Abstract: Objective: The present study aimed to investigate the relationship between physical self-efficacy and body mass index in a large sample of schoolchildren. Methods: The Perceived Physical Ability Scale for Children was administered to 1560 children (50.4% boys; 8-12 years) from three different countries. Weight and height were also recorded to obtain the body mass index. Results: In agreement with the literature, the boys reported greater perceived physical self-efficacy than girls. Moreover, the number of boys who are obese is double that of girls, while the number of boys who are underweight is half that found in girls. In the linear regression model, the increase in body mass index was negatively related to the physical self-efficacy score, differently for boys and girls. Furthermore, age and nationality also were predictors of low physical self-efficacy only for girls. Conclusion: The results of this study reinforce the importance of psychological aspect of obesity, as the perceived physical self-efficacy and body mass index were negatively associated in a sample of schoolchildren for boys and girls.

Resumo: Objetivo: Investigar a relação entre a autoeficácia física e o índice de massa corporal em uma grande amostra de crianças em idade escolar. Métodos: A Escala de Capacidade Física Percebida para Crianças foi administrada a 1.560 crianças (50,4% meninos; 8-12 anos) de três países diferentes. O peso e a altura também foram registrados para obter o índice de massa corporal. Resultados: De acordo com a literatura, os meninos relataram maior autoeficácia física percebida do que as meninas. Além disso, o número de meninos obesos é o dobro do de meninas, ao passo que o número de meninos abaixo do peso é metade do de meninas. No modelo de regressão linear, o aumento no índice de massa corporal foi negativamente relacionado ao escore de autoeficácia física, diferentemente em meninos e meninas. Além disso, a idade e a nacionalidade também foram preditoras de autoeficácia física baixa apenas para meninas. Conclusão: Os resultados deste estudo reforçam a importância do aspecto psicológico da obesidade, uma vez que a autoeficácia física percebida e o índice de massa corporal foram negativamente associados em uma amostra de crianças em idade escolar para meninos e meninas.

Spanish translation of the mood rhythm instrument: a novel approach to mood evaluation

Introduction: The Mood Rhythm Instrument (MRI) is a questionnaire developed to assess the circadian rhythm of mood-related behaviors. The aim of this study was to translate this instrument from Brazilian Portuguese into Spanish. Methods: The translation process consisted of forward translation, adjustment, back translation, back translation review and harmonization. Results: Comparing the initial Spanish translation and the final Spanish version, there were no semantic differences and the items were not changed. Conclusions: The Spanish version of the MRI is ready to be tested in a Spanish population. In the future, assessing and comparing mood-related behaviors in transcultural studies will be possible(AU)

The Mood Rhythm Instrument: development and preliminary report

Objective: To describe the initial steps in the development and validation of a new self-reported instrument designed to assess daily rhythms of mood symptoms, namely, the Mood Rhythm Instrument. Methods: A multidisciplinary group of experts took part in systematic meetings to plan the construction of the instrument. Clarity of items, their relevance to evaluation of mood states, and the consistency of findings in relation to the available evidence on the biological basis of mood disorders were investigated. The internal consistency of the questionnaire was evaluated through Cronbach’s alpha. Results: All of the items proposed in a first version were well rated in terms of clarity. The items more frequently rated as “rhythmic” were related to the somatic symptoms of mood. Their peaks in 24 hours were more frequent in the morning. The items associated with affective symptoms of mood were rated as less rhythmic, and their peak in 24 hours occurred more frequently in the afternoon and evening. Males and females behaved more similarly with respect to somatic than behavioral-affective items. The second version of the Mood Rhythm Instrument had a Cronbach’s alpha of 0.73. Conclusion: The proposed Mood Rhythm Instrument may be able to detect individual rhythms of cognitive and behavioral measures associated with mood states. Validation in larger samples and against objective measures of rhythms, such as actigraphy, is warranted.

Differential susceptibility of BALB/c, C57BL/6N, and CF1 mice to photoperiod changes

Objective:Circadian disturbances common to modern lifestyles have been associated with mood disorders. Animal models that mimic such rhythm disturbances are useful in translational research to explore factors contributing to depressive disorders. This study aimed to verify the susceptibility of BALB/c, C57BL/6N, and CF1 mice to photoperiod changes.Methods:Thermochron iButtons implanted in the mouse abdomen were used to characterize temperature rhythms. Mice were maintained under a 12:12 h light-dark (LD) cycle for 15 days, followed by a 10:10 h LD cycle for 10 days. Cosinor analysis, Rayleigh z test, periodograms, and Fourier analysis were used to analyze rhythm parameters. Paired Student's t test was used to compare temperature amplitude, period, and power of the first harmonic between normal and shortened cycles.Results:The shortened LD cycle significantly changed temperature acrophases and rhythm amplitude in all mouse strains, but only BALB/c showed altered period.Conclusion:These findings suggest that BALB/c, the preferred strain for stress-induced models of depression, should also be favored for exploring the relationship between circadian rhythms and mood. Temperature rhythm proved to be a useful parameter for characterizing rhythm disruption in mice. Although disruption of temperature rhythm has been successfully documented in untethered mice, an evaluation of desynchronization of other rhythms is warranted.

Mudança de fotoperíodo: proposta de modelo experimental / Change of photoperiod: proposal for an experimental model

Introduction: There are some physiological and behavioral variations related to seasonality, and light is the major synchronizer of these variations according to the seasonal functions in temperate latitudes. Thus, the objective of this study was to validate a methodology for photoperiod modification in Wistar rats byevaluating its interference in the biological rhythm. Methods: Three male adult Wistar rats (60 days) were exposed to 3 photoperiods of 17 days each, with different light/dark cycles (LD): LDPP/SDPP Animal, exposed to initial LD 16:30/07:30 (LDPP, long-day photoperiod) and final LD 07:30/16:30 (SDPP, short-day photoperiod); SDPP/LDPP Animal, exposed to initial LD 07:30/16:30 and final LD 16:30/07:30; and final LD 16:30/07:30; and CT Animal, under constant LD 12:00/12:00. LDPP/SDPP and SDPP/LDPP animals underwent an intermediate photoperiod between initial and final LD, in which light exposure was increased or reduced by 30 min each day until the photoperiods were inverted. All animals remained isolated during the study and had their core temperatures continuously measured by sensors implanted in the peritoneal cavity and their locomotive activity assessed by sensors attached to their cages. The data obtained were used to construct histograms. Results: LDPP/SDPP and SDPP/LDPP animals had a longer period of activity in the SDPP than in the LDPP. The temperature of the CT animal followed a rhythmic pattern. The rat strain used was sensitive to changes in photoperiod. Conclusions: The model proposed and validated in this study can be used in experiments that aim to assess the consequences of changes in light exposure.

Introdução: Existem variações fisiológicas e comportamentais relacionadas à sazonalidade, e a luz é o principal sincronizador destas variações de acordo com as funções sazonais em latitudes de climas temperados. Sendo assim, o objetivo deste estudo foi validar uma metodologia de modificação de fotoperíodo com ratos Wistar avaliando sua interferência no ritmo biológico. Métodos: Três ratos Wistar machos adultos (60 dias) foram expostos a 3 fotoperíodos de 17 dias cada, com diferentes ciclos claro/escuro (light/dark, LD): Animal CL/CC, exposto a LD inicial 16:30/07:30 (CL, claro longo) e LD final 07:30/16:30 (CC, claro curto); Animal CC/CL, exposto a LD inicial 07:30/16:30 e LD final 16:30/07:30; e Animal CT, sob LD constante 12:00/12:00. Os animais CL/CC e CC/CL passaram por um fotoperíodo intermediário entre o LD inicial e final, no qual a exposição à luz foi aumentada ou diminuída em 30 min a cada dia até que os fotoperíodos se invertessem. Todos os animais permaneceram isolados durante o estudo e tiveram suas temperaturas corporais continuamente aferidas por sensores implantados na cavidade peritoneal e suas atividades locomotoras medidas por sensores acoplados às suas caixas. Os dados obtidos foram utilizados para construção de histogramas. Resultados: Os animais CL/CC e CC/CL apresentaram maior período de atividade em CC do que em CL. A temperatura do animal CT seguiu um padrão rítmico. A linhagem utilizada apresentou sensibilidade à mudança de fotoperíodo. Conclusão: O modelo proposto e validado neste estudo pode ser usado em experimentos que tenham como objetivo avaliar as consequências das mudanças de exposição à luz.

Chronotype: a review of the advances, limits and applicability of the main instruments used in the literature to assess human phenotype / Cronotipo: uma revisão dos avanços, limites e aplicabilidade dos principais instrumentos utilizados na literatura para avaliar o fenótipo humano

The study of circadian typology differences has increased in the last few years. As a result, new instruments have been developed to estimate the individual circadian phase of temporal human behavior, also referred as chronotype. The current review was conducted to evaluate the differences among the questionnaires most frequently used to assess chronotype: the Morningness-Eveningness Questionnaire (MEQ), the Composite Scale of Morningness (CSM), and the Munich Chronotype Questionnaire (MCTQ). Each instrument evaluates a different aspect of chronotype. MEQ is considered to evaluate the phase preferences of individual behavior over a 24-hour day, while MCTQ measures the phase of sleep positions for both free and work days. CSM is similar to MEQ, but is more sensitive to measure shift work. The concept of chronotype has been used to refer to phase positions or phase preferences in the literature reviewed. Most of the time this is a consequence of different interpretations: it is not clear whether phase preferences are a direct manifestation of the individual’s internal clock or a result of external cues, e.g., social interaction (including the alarm clock). Also, phase preferences are not uniform throughout life. Therefore, a single assessment, not taking age into consideration, will not accurately describe the sample. We suggest that MCTQ is the best instrument for investigators dealing with desynchronization and as an instrument for sleep phase. Conversely, if the goal is to assess characteristics that change under specific situations - chronotype -, the MEQ should be used

O estudo das diferenças de tipologia circadiana tem aumentado nos últimos anos. Como resultado, novos instrumentos têm sido desenvolvidos para estimar as preferências interindividuais de fase circadiana, denominada de cronotipo, responsável pela organização temporal do processo de regulação do organismo. O objetivo desta revisão foi avaliar as diferenças dos principais questionários utilizados para avaliar cronotipos: o Questionário de Matutinidade e Vespertinidade (Morningness-Eveningness Questionnaire, MEQ), o Composite Scale of Morningness (CSM) e o Questionário de Cronotipo de Munique (Munich Chronotype Questionnaire, MCTQ). Cada instrumento avalia um aspecto diferente dos cronotipos. Considera-se que o MEQ avalia as preferências de fase do comportamento individual ao longo de um dia de 24 horas, ao passo que o MCTQ mede a posição da fase de sono tanto em dias livres como em dias de trabalho. O CSM é semelhante ao MEQ, mas é mais sensível para ser utilizado em indivíduos que realizam trabalho em turnos. O conceito de cronotipo tem sido utilizado para se referir a posições de fase ou preferências de fase na literatura revisada. Na maioria das vezes, isso é consequência de diferentes interpretações: não está claro se as preferências de fase são uma manifestação direta do relógio interno do indivíduo ou um resultado de sinais externos, como por exemplo, interação social (incluindo o uso de despertador). Além disso, as preferências de fase não são uniformes ao longo da vida. Sendo assim, uma única avaliação, sem levar em consideração a idade do indivíduo nos escores utilizados nessas escalas, não descreverá a amostra com precisão. Sugerimos, através desta revisão, que o MCTQ deve ser considerado como instrumento para investigações que lidam com dessincronização e como instrumento de medida de fase de sono. Por outro lado, se o objetivo é avaliar características que mudam em determinadas situações - cronotipo -, o MEQ deve ser utilizado

Desenvolvimento da versão breve da Escala de Ritmo Social / Development of brief version of the Social Rhythm Metric

OBJETIVO: O objetivo deste trabalho é o estabelecimento de uma versão abreviada da Escala de Ritmo Social, com vistas à aplicação em pesquisa. MÉTODOS: Tomando como padrão-ouro a Escala de Ritmo Social de 17 itens, estabelecidas três versões breves a partir de três critérios diferentes. Comparados escores de regularidade e quantidade de atividades desenvolvidas em um período de uma semana de 167 sujeitos saudáveis, 25 portadores de epilepsia mioclônica juvenil e 16 portadores de transtorno depressivo. RESULTADOS: A versão breve de seis itens mostrou melhor concordância com relação ao padrão-ouro k = 0,51; p < 0,001. A análise bivariada demonstrou significativa correlação entre a versão breve-6 e o padrão-ouro: (r = 0,87; p < 0,001). Houve correlação com idade na versão breve-6 (r = 0,2; p < 0,001), ainda mais significativa do que no padrão-ouro (r = 0,2; P < 0,01). Na análise ANOVA, o grupo saudável apresentou escores mais altos de regularidade em ambas as escalas. Com relação à quantidade de atividades, o grupo saudável assemelhou-se ao dos portadores de epilepsia e o dos portadores de depressão apresentou médias mais baixas. CONCLUSÃO: A simplificação da escala diminui a porcentagem de itens não preenchidos e custo em material impresso e facilita a padronização. O processo envolveu cuidadosa análise da adequação do instrumento à cultura-alvo.

OBJECTIVE: The objective of this work was to establish a brief version of the Social Rhythm Metric, aimed at applying it in research. METHODS: Taking the 17-item Social Rhythm Metric as the gold standard, three brief versions were created based on three different criteria. compared the scores of the regularity and quantity of activities carried out in a week for 167 healthy subjects and 25 individuals with juvenile myoclonic epilepy and 16 with depressive disturbance. RESULTS: The brief version of 6 items showed better concordance in relation to the gold standard; k = 0.51, p < 0.001. Bivariate analysis demonstrated a significant correlation between the brief version 6 and the gold standard (r = 0.87; p < 0.001). There was a correlation with age in the brief 6 version (r = 0.2; p < 0.001), even more significant than in the gold standard (r = 0.2; P < 0.01). ANOVA showed higher scores for regularity in the healthy using both scales. However, in relation to the quantity of activities, the healthy group resembled the epilepsy group, and the individuals with depression showed lower means. CONCLUSION: The simplification of the Social Rhythm Metric decreased the percenta-ge of items not filled in and the cost of printed matter and facilitate the standardization. The process involved a careful analysis of suitability of the instrument for the target culture.

O conceito de tempo na percepção de crianças e adolescentes / The concept of time in the perception of children and adolescents

INTRODUCTION: Children and adolescents use different markers to elaborate the concept of time, and such markers change along their development. The objective of the present article was to analyze changes in time concepts in different age groups. METHODS: The study included 81 children and adolescents aged 6 to 17 years, attending elementary or high school at a public school in southern Brazil. Participants were asked to provide their definition of time, either orally (children) or in writing (older children and adolescents). RESULTS: Twenty-one words were identified as related with the definition of time. The term "hours" was the most frequently cited (24.7%), followed by "clock" and "family" (11.1% each). Among children aged 6 to 8 years, "family" was the term most frequently mentioned to refer to time. Between 9 to 11 years of age, the notion of time was essentially related to the use of a clock, and in the 12-17-year age group, time was mostly associated with the word "days." The word "family" appears to be a frequent temporal marker in childhood, but loses this function during adolescence, as new social relationships are established. CONCLUSION: The results of this study show that the concept of time varies according to age. Chronobiological studies should therefore take into consideration the temporal perception peculiar to each age group.

INTRODUÇÃO: Crianças e adolescentes utilizam diferentes marcadores para a construção do conceito de tempo, os quais se modificam ao longo do desenvolvimento. O objetivo deste artigo foi analisar mudanças em conceitos temporais e suas transições ao longo da idade. MATERIAL E MÉTODOS: Participaram do estudo 81 crianças e adolescentes com idade entre 6 e 17 anos, estudantes do ensino médio e fundamental de uma escola pública do sul do Brasil. Solicitou-se aos participantes que informassem sua definição de tempo, verbalmente (crianças) ou por escrito (crianças mais velhas e adolescentes). RESULTADOS: Foram identificadas 21 palavras relacionadas com a definição de tempo. O termo "horas" foi o mais citado (24,7%), seguido de "relógio" e "família" (11,1% cada). Entre 6 e 8 anos, o termo "família" foi o mais frequentemente mencionado para se referir ao tempo. Entre 9 e 11 anos, a noção de tempo esteve relacionada ao uso do relógio, e entre 12 e 17 anos, o tempo foi associado principalmente à palavra "dias". Na infância, o termo "família" é um marcador temporal recorrente, mas perde tal significado na adolescência, à medida que surgem novas relações sociais. CONCLUSÃO: Os resultados deste estudo mostraram que o conceito de tempo varia conforme a idade. Portanto, estudos cronobiológicos devem considerar a percepção temporal própria para cada faixa etária.

Avaliação do impacto da exposição a agrotóxicos sobre a saúde de população rural: Vale do Taquari (RS, Brasil) / Evaluation of the impact of exposure to pesticides on the health of the rural population: Vale do Taquari, State of Rio Grande do Sul (Brazil)

Este estudo transversal teve o objetivo de avaliar possível associação entre contato com agrotóxicos e prevalência de doenças crônicas em população rural do Sul do Brasil. Três municípios foram aleatoriamente escolhidos. A amostra selecionada por conveniência foi recrutada durante três meses (2005) e se compôs de 298 sujeitos de ambos os sexos, com idade entre 18 e 65 anos e que procuravam farmácia pública ou privada para a compra de medicamentos. Os dados obtidos, mediante entrevistas estruturadas, demonstraram que 68,4 por cento dos entrevistados exerciam atividade rural, dos quais 74,8 por cento eram membros de famílias de agricultores e tinham contato com agrotóxicos. A média de idade foi 51±16,5 anos para os entrevistados com contato com agrotóxicos e 50±17,9 anos para os sem contato. A amostra foi constituída de 36,2 por cento por homens e 57,7 por cento dos indivíduos que apresentavam mais de quatro anos de estudo. O contato direto ou indireto com agrotóxicos associou-se ao relato de várias doenças, sendo as neurológicas e as orais as mais prevalentes. Houve associação com relato de condições dolorosas, de modo que indivíduos com contato com agrotóxicos apresentaram em torno de duas vezes mais chances de as referirem. Os dados corroboram os da literatura e indicam a necessidade de promoção de medidas de proteção e prevenção da saúde da população rural.

The scope of this cross-sectional study was to assess a possible link between contact with pesticides and the prevalence of chronic disease in the rural population in the south of Brazil. Three municipalities were randomly chosen. The sample selected was recruited over three months (2005) and was composed of 298 subjects of both sexes, between 18 and 65 years of age, who frequented public or private pharmacies for the purchase of medication. Data obtained by means of structured interviews revealed that 68.4 percent of those interviewed worked in rural activities, and 74.8 percent of these were members of families working in agriculture with contact with pesticides. The average age was 51+16.5 years of age for the interviewees with contact with pesticides and 50+17.9 years for those without contact. The sample was composed of 36.2 percent of men, and 57.7 percent of the individuals had more than four years of education. Direct or indirect contact with pesticides was associated with the report of several diseases, with neurological and oral diseases being the most prevalent. There was a link with painful conditions and individuals with contact with pesticides reported twice as many diseases. The data corroborate the literature and draw attention to the need for promoting measures to protect the health of the rural population.

Prevalence of psychiatric comorbidities in temporal lobe epilepsy in a Southern Brazilian population / Prevalência de comorbidades psiquiátricas na epilepsia do lobo temporal em uma população do sul do Brasil

A great prevalence of psychiatric disorders in epilepsy is well demonstrated, although most studies have used unstructured psychiatric interviews for diagnosis. Here we present a study evaluating the prevalence of psychiatric comorbidities in a cohort of Southern Brazilian patients with temporal lobe epilepsy (TLE) using a structured clinical interview. We analyzed 166 patients with TLE regarding neuropsychiatric symptoms through the Structured Clinical Interview for DSM-IV. One hundred-six patients (63.9 percent) presented psychiatric comorbidities. Mood disorders were observed in 80 patients (48.2 percent), anxiety disorders in 51 patients (30.7 percent), psychotic disorders in 14 (8.4 percent), and substance abuse in 8 patients (4.8 percent) respectively. Our results agree with literature data where most authors detected mental disorders in 10 to 60 percent of epileptic patients. This wide variation is probably attributable to different patient groups investigated and to the great variety of diagnostic methods. Structured psychiatric interviews might contribute to a better evaluation of prevalence of psychiatric comorbidities in TLE.

Embora muitos estudos tenham demonstrado uma alta prevalência de transtornos psiquiátricos em pacientes com epilepsia, a maioria utilizou entrevistas psiquiátricas não-estruturadas para o diagnóstico. Este método pode levar a diferenças significativas nos resultados. Nós estudamos a prevalência de comorbidades psiquiátricas em pacientes com epilepsia do lobo temporal (ELT), utilizando uma entrevista clínica estruturada. Foram estudados 166 pacientes com ELT, aos quais foi aplicada a Entrevista Clínica Estruturada para o DSM-IV (SCID). Cento e seis pacientes (63,9 por cento) apresentaram comorbidades psiquiátricas. Transtornos de humor, observados em 80 pacientes (48,2 por cento), foram o transtorno neuropsiquiátrico mais comum. Transtornos de ansiedade, observados em 51 pacientes (30,7 por cento), foram a segunda comorbidade psiquiátrica mais frequente. Transtornos psicóticos foram encontrados em 14 (8,4 por cento), e abuso de substâncias foram observados em 8 pacientes (4,8 por cento), respectivamente. Nossos resultados estão de acordo com os dados da literatura, que demonstra problemas psiquiátricos em 10-60 por cento dos pacientes com epilepsia. A grande variação dos resultados pode ser atribuída aos diferentes grupos de pacientes estudados e à variabilidade de métodos diagnósticos empregados. Entrevistas psiquiátricas estruturadas podem contribuir para uma avaliação mais adequada da real prevalência de comorbidades psiquiátricas na ELT.

Avaliação de fatores associados ao diagnóstico de queimação bucal: um estudo preliminar / Evaluation of factors associated to diagnosis of burning mouth: a preliminary study

Objetivo: avaliar fatores associados ao diagnóstico de ardência bucal como xerostomia, hipossalivação, sintomas depressivos, ansiedade, transtornos de sono, doenças sistêmicas e uso contínuo de medicamentos. Métodos: foram avaliados 22 pacientes atendidos em nível ambulatorial através de escalas validadas e questionário sociodemográfico, seguido de medidas de fluxo salivar espontâneo e estimulado através do método de expectoração salivar. Na análise estatística descritiva foi utilizado SPSS 16.0. Resultados: a amostra foi composta por 4 homens e 18 mulheres com idade média de 61,6+2,83 anos. As médias de fluxo salivar espontâneo e estimulado foram 0,27+0,06 ml/min e 0,84+0,08 ml/min, respectivamente. A hipossalivação esteve presente em 54,5% dos casos, sendo que a xerostomia foi referida por 31,3% dos pacientes. Sintomas depressivos leves foram observados em 22,7% da amostra. Na avaliação de ansiedade-traço 31,8% apresentaram sintomas de ansiedade moderada, 63,6%, sintomas de ansiedade elevada e 4,5%, ansiedade muito elevada. Quanto à avaliação de ansiedade-estado 27,3% apresentaram sintomas de ansiedade moderada e 72,7% sintomas de ansiedade elevada. Setenta e sete por cento apresentaram alterações de sono. Os exames sorológicos não apresentaram alterações significativas. Conclusão: estes resultados sugerem associação entre os parâmetros comportamentais avaliados e os sintomas bucais, sendo necessário o aumento da amostra para que possamos confirmar estatisticamente essa tendência.

Aim: to evaluate factors associated with the diagnosis of burning mouth, such as dry mouth, hyposalivation, depressive symptoms, anxiety, sleep disorders, systemic diseases, and continuous use of medications. Methods: twenty-two patients recruited from outpatient clinics were assessed using validated scales and a sociodemographic questionnaire. Patients’ spontaneous and stimulated salivary flow rates were also measured using saliva expectoration. SPSS 16.0 was used in the descriptive statistical analysis. Results: the sample consisted of 4 men and 18 women whose mean age was 61.6±2.83 years. The mean of spontaneous and stimulated salivary flow rates were 0.27+0.06 mL/min and 0.84+0.08 mL/min, respectively. Hyposalivation was present in 54.5% of cases, and dry mouth was reported by 31.3% of patients. Mild depressive symptoms were observed in 22.7% of the sample. When assessing anxiety-trait, we found that 31.8% had moderate symptoms of anxiety, 63.6% had symptoms of high anxiety, and 4.5% had very high anxiety. The assessment of anxiety-status showed that 27.3% and 72.7% had moderate and elevated anxiety symptoms, respectively. Seventy-seven percent had sleep disorders. Serological tests showed no significant changes. Conclusion: Our findings suggest an association between the behavioral parameters evaluated and the oral symptoms, indicating the need for a larger sample to confirm this trend using statistical analysis.

Adaptação transcultural da versão brasileira da escala Social Rhythm Metric-17 (SRM-17) para a população angolana / Cross-cultural adaptation of the Brazilian version of the Social Rhythm Metric-17 (SRM-17) for the population of Angola

INTRODUÇÃO: O ritmo social é um conceito que integra a relação entre Zeitgebers (sincronizadores) sociais e os marcadores de tempo endógenos, e pode ser avaliado com a Escala de Ritmo Social (Social Rhythm Metric-17, SRM-17). O objetivo deste estudo foi realizar a adaptação da versão brasileira da SRM-17 para o português angolano, comparando as duas escalas em populações que utilizam o mesmo idioma mas apresentam diferenças culturais. MÉTODOS: A versão brasileira da SRM-17 foi submetida à avaliação de 10 estudantes universitários angolanos, que analisaram o grau de clareza de cada um dos 15 itens do instrumento usando uma escala visual analógica de 10 cm e propuseram modificações ao texto. Foi realizada revisão dos resultados para a elaboração da versão final, bem como prova de leitura e relatório final. RESULTADOS: A versão final angolana manteve uma equivalência de itens com relação à versão em português brasileiro. A versão avaliada demonstrou um grau satisfatório de clareza e equivalência semântica na maioria dos itens. Porém, alguns itens apresentaram um escore na clareza inferior à média aritmética de compreensão global do instrumento (8,38±1,0). CONCLUSÃO: Apesar de o português ser o idioma oficial nos dois países, há diferenças culturais significativas nas duas populações. Este trabalho apresenta uma versão adaptada à realidade angolana de um instrumento específico para aferir ritmo social. O processo de adaptação transcultural deve efetivar-se com estudos de validação do instrumento final em uma amostra maior da população, onde também poderão ser avaliadas as equivalências operacional, de medida e funcional.

INTRODUCTION: Social rhythm is a concept that correlates social Zeitgebers (synchronizers) with endogenous markers of time, and can be assessed with the Social Rhythm Metric-17 (SRM-17). The aim of this study was to adapt the Brazilian version of the SRM-17 to Angolan Portuguese, comparing the two scales in samples that speak the same language but have cultural differences. METHODS: The Brazilian version of the SRM-17 was assessed by 10 Angolan students who analyzed the intelligibility of the 15 sentences contained in the instrument using a 10-cm visual analog scale and proposed changes to the text. Results were reviewed for the generation of a final Angolan version, followed by a reading test and the production of a final report. RESULTS: The final Angolan version of SRM-17 maintained an equivalence of items in relation to the Brazilian Portuguese version. The version assessed by the students showed a satisfactory degree of intelligibility and semantic equivalence in most items. However, some items presented intelligibility results below the mean total scores of the scale (8.38 ± 1.0). CONCLUSION: Although the populations of Brazil and Angola speak the same language, significant cultural differences were found between the two countries. This paper presents an instrument to assess social rhythm adapted to the Angolan culture. The cross-cultural adaptation process herein described should be continued by validating the final version of the instrument in a larger sample and by assessing operational, functional, and measure equivalence.

Prevalencia de transtornos mentais menores e subdiagnóstico de sintomas depressivos em mulheres na atenção primária / Prevalence of minor mental disorders and underdiagnosis of depressive symptoms in women in primary care

Introdução: transtornos mentais representam 13% da carga de doença no mundo. Apesar destasconstatações, a lacuna entre a oferta e a procura de cuidados de saúde mental é grande. Um dosfatores principais que contribuem para esta situação é o subdiagnóstico de transtornos mentais.Objetivos: esse estudo descreve a prevalência de sintomas psiquiátricos menores e depressivosem mulheres na atenção primária.Métodos: 201 mulheres foram recrutadas. Utilizou-se Self Reporting Questionnaire - 20>8 eduas perguntas do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-IV-TR) paradiagnóstico de depressão.Resultados: cinquenta e três por cento das pacientes apresentaram SRQ> 8. Pacientes que responderam“sim” às perguntas 1 e 2 apresentaram maior escore no SRQ-20 (10,7+0,38; 11,01+0,41 respectivamente;P<0,01). 24,7% responderam “sim” a uma questão; 43,7% responderam “SIM” à ambas. Entre as não-usuáriasde psicofármacos, 40,5% têm SRQ>8. Entre aquelas com SRQ-20>8, 70,8% não usavam psicofármacos.Conclusão: mais da metade das pacientes apresentou sintomas depressivos e menos de 20%estavam utilizando antidepressivo no momento da entrevista, evidenciando subtratamento dotranstorno. Estes resultados podem estar relacionados à falta de mecanismos adequados para omanejo da depressão na atenção primária.

Mental disorders account for 13% of disease burden worldwide. Despite these findings, the gap between supply and demand for mental health care is great. One of the main factors contributing to this situation is the underdiagnosis of mental disorders. Aims: to describe the prevalence of minor psychiatric symptoms and depression in women in primary care. Methods: two-hundred and one women were recruited. We used the Self Reporting Questionnaire 20 (SRQ-20) > 8 and two questions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) for depression diagnosis. Results: fifty-three percent of patients had SRQ-20 ¡Ý 8. Patients who answered ¡°YES¡± to questions 1 and 2 had higher scores on the SRQ-20 (10.7¡À0.38; 11.01¡À0.41, respectively; p < 0.01); 24.7% answered ¡°YES¡± to one question; and 43.7% answered ¡°YES¡± to both. Among non-users of psychotropic drugs, 40.5% had SRQ-20 ¡Ý 8. Among those with SRQ-20 ¡Ý 8, 70.8% were not using psychotropic drugs. Conclusion: more than half of the patients had depressive symptoms and less than 20% were using antidepressants at the time of the interview, showing undertreatment of the disorder. These results may be related to lack of adequate mechanisms for the management of depression in primary care.

Correlation of shift work and waist circumference, body mass index, chronotype and depressive symptoms / Correlação entre trabalho de turno e circunferência abdominal, índice de massa corporal, cronotipo e sintomas depressivos

OBJECTIVE: Correlate shift work with body mass index (BMI), waist circumference, chronotype and depressive symptoms. SUBJECTS AND METHODS: This study comprising 14 shift workers and 13 day workers. Subjects were workers from the health area aged 25 to 60 years. Minor psychiatric disorders were accessed by Self Report Questionnaire (SRQ-20) and depressive symptoms by Beck Depression Inventory (BDI). Chronotype was accessed using Morningness-Eveningness Questionnaire (MEQ). Anthropometric measures were taken. RESULTS: Shift workers presented higher BMI (P = 0.03) and waist circumference (P = 0.004) than day workers. Years on shift work were significantly correlated to waist circumference (r = 0.43; P = 0.03) and age (r = 0.47; P = 0.02). Shift work was not correlated with depressive symptoms and chronotype. CONCLUSION: These results may suggest a role played by shift work on the development and/or the early clinic manifestations of metabolic disturbances, becoming a risk factor to metabolic syndrome.

OBJETIVO: Correlacionar o trabalho de turno com índice de massa corporal (IMC), circunferência abdominal, cronotipo e sintomas depressivos. SUJEITOS E MÉTODOS: Amostra de 14 trabalhadores de turno e 13 diurnos, com idade entre 25 e 60 anos. Transtornos psiquiátricos menores foram aferidos pelo Self Report Questionnaire (SRQ-20), sintomas depressivos pelo inventário de Depressão de Beck (BDI) e o cronotipo pelo Morningness-Eveningness Questionnaire (MEQ). As medidas antropométricas foram mensuradas. RESULTADOS: Trabalhadores de turno apresentaram maior IMC (P = 0,03) e circunferência abdominal (P = 0,004) quando comparados aos diurnos. O tempo de trabalho de turno foi correlacionado à circunferência abdominal (r = 0,43; P = 0,03). Não houve correlação entre trabalho e sintomas depressivos e cronotipo. CONCLUSÃO: Os resultados podem sugerir que o trabalho de turno desempenhe um papel no desenvolvimento e/ou nas precoces manifestações clínicas de distúrbios metabólicos, tornando-se um fator de risco para a síndrome metabólica.

Ritmo social e suas formas de mensuração: uma perspectiva histórica / Social rhythm and theirs measurement types: a historical overview

O presente estudo tem como objetivo descrever o conceito de ritmo social e suas formas de mensuração descritas na literatura dentro de uma perspectiva histórica. Ritmo social não é um ritmo biológico, mas interfere na sincronização de ritmos biológicos e caracteriza-se pela regularidade da vida diária determinada pelas relações sociais, ou seja, exposição regular aos zeitgebers sociais, estes definidos como agentes sincronizadores externos inseridos em um determinado contexto social. O estudo do ritmo social pode trazer reflexões sobre a organização temporal da sociedade, revelando os efeitos perniciosos da incompatibilidade entre demandas sociais e ritmos biológicos no campo do trabalho, esclarecendo de que maneira o estabelecimento das relações pode ter impacto na qualidade de vida e possibilitando que as pessoas possam repensar sua organização

The present study aims to describe the concept of social rhythm and theirs measurement types described in the literature under a historic perspective. Social rhythms is not like biological rhythms, however they interfere in the biological rhythms synchronization and they are characterized by regularly social zeitgebers exposure defined as external synchronic agent inserted in a determinated social context. Studying of social rhythm can bring reflexions about temporal organization of society, revealing the noxious effects of incompatibility between social demands and biologic rhythms in work field, clearing how the relationships can make impact in quality of life and allowing that people can think about their organization