Trastornos del sueño en emergencias y desastres / Sleep disorders in emergencies and disasters

Los trastornos del sueño son frecuentes en la población y una causa importante de morbilidad. El objetivo de esta revisión es evaluar las alteraciones del sueño en periodos de emergencia y desastres. A lo largo de la historia, la esfera biopsicosocial y el sueño de las personas ha sido abrumada por múltiples eventos a gran escala, tales como desastres naturales, tragedias provocadas por el hombre, conflictos bélicos, crisis sociales y pandemias, cuya experiencia puede derivar en problemas de salud a corto, mediano y/o largo plazo. En los estudios analizados, se ha observado el impacto negativo de las emergencias y desastres en el sueño, por lo que ha cobrado gran relevancia la difusión y promoción de medidas que incentiven el buen dormir. Debido a la llegada del COVID-19 y a la situación de confinamiento por periodos prolongados en el hogar para prevenir su propagación, han surgido importantes consecuencias a nivel social. Ciertos factores ocupacionales y características de los desastres se asocian a mayor comorbilidad, un alto riesgo de experimentar agotamiento físico, trastornos psicológicos e insomnio en grupos altamente vulnerables, como lo son los profesionales de la salud, rescatistas y socorristas. El insomnio es el trastorno de sueño más frecuente en la población general y su empeoramiento en el contexto de pandemia por COVID-19 representa un nuevo problema en salud pública. Es por ello, que es indispensable promover campañas de prevención de salud física y mental orientados a la pesquisa precoz y manejo de patologías de la esfera psicosocial, dentro de las posibilidades socioeconómicas.

Sleep disorders are common in the population and are major cause of morbidity. The objective of this review is to assess sleep disturbances in times of emergency and disasters. Throughout history, the biopsychosocial field and sleep have been affected by multiple large-scale events, such as natural disasters, man-caused tragedies, armed conflicts, social crises and pandemics, the experience of which can lead to short, medium and/or long term health problems. In several studies, the negative impact of emergencies and disasters on sleep have been analyzed, emphasizing the importance of the diffusion and promotion of measures that encourage good sleep. The arrival of COVID-19 and consequent home confinement for prolonged periods caused important social consequences. Certain occupational factors and characteristics of disasters are associated with greater comorbidity: a high risk of experiencing physical exhaustion, psychological disorders and insomnia, especially in highly vulnerable groups, such as health professionals, rescuers and first aids-responders. Insomnia is the most frequent sleep disorder in the general population and its worsening in the context of the COVID-19 pandemic, represents a new public health problem. It is essential to promote physical and mental health prevention campaigns, aimed at early screening and management of pathologies in the psychosocial sphere, within socioeconomic possibilities.

Influence of swimming on sleep and quality of life of people with visual impairments / Influencia de la práctica de natación en el sueño y en la calidad de vida de personas con discapacidad visual / Influência da prática de natação no sono e na qualidade de vida de pessoas com deficiência visual

ABSTRACT Introduction: Physical exercise can bring important benefits in the areas of physical and psychological health and behavioral aspects. However, there have been few studies that link physical exercise and sleep in people with disabilities. Objective: This study aims to analyze the benefits promoted by swimming in the health and quality of sleep of visually impaired people of different levels of physical fitness. Methods: Thirty male volunteers, visually impaired, aged 16-60 years, took part in the study. The volunteers were divided into three groups: irregularly active (G1), swimming twice a week (G2), and swimming five times a week (G3). Questionnaires related to sleep pattern (Pittsburgh), sleepiness (Epworth), chronotype (Horne and Östberg) and quality of life (SF-36) were applied. Results: The main results showed that G3 presented better quality of sleep, as well as more effective sleep, compared to the other two groups. In addition, G1 showed poorer scores for quality of life compared to G3 in the domains general health, vitality, and social aspect. Conclusion: We suggest that more frequent physical activity (swimming) has a positive effect on quality of sleep and quality of life of people with visual impairments. Level of evidence III, case control study .

RESUMEN Introducción: La práctica del ejercicio físico puede traer beneficios importantes en el ámbito físico, psicológico y comportamental. Sin embargo, la literatura es escasa al relacionar ejercicio físico y sueño en las personas con discapacidad. Objetivo: Este estudio tuvo como objetivo analizar los beneficios que la natación promueve en la salud y en la calidad del sueño de discapacitados visuales con diferentes niveles de aptitud física. Métodos: Participaron en la investigación 30 voluntarios del sexo masculino, discapacitados visuales, con edad entre 16 y 60 años, divididos en tres grupos, a saber, irregularmente activos (G1), practicantes de natación 2 veces por semana (G2) y practicantes de natación 5 veces por semana (G3). Fueron aplicados los cuestionarios relacionados con el patrón de sueño (Pittsburgh), somnolencia (Epworth), cronotipo (Horne y Östberg) y calidad de vida (SF-36). Resultados: Los principales resultados mostraron que G3 presentó mejor calidad de sueño, bien como mayor eficiencia del sueño con relación a los otros dos grupos. Además, G1 demostró peores puntajes para calidad de vida con relación a G3 en los dominios estado general de salud, vitalidad y aspecto social. Conclusión: De esa forma, podemos sugerir que la frecuencia mayor en la práctica de actividad física (natación) actuó positivamente sobre la calidad del sueño y la calidad de vida de las personas con discapacidad visual. Nivel de evidencia III; Estudio de caso control .

RESUMO Introdução: A prática do exercício físico pode trazer benefícios importantes no âmbito físico, psicológico e comportamental. No entanto, a literatura é escassa ao relacionar exercício físico e sono nas pessoas com deficiência. Objetivo: Este estudo teve como objetivo analisar os benefícios que a natação promove na saúde e na qualidade do sono de deficientes visuais com diferentes níveis de aptidão física. Métodos: Participaram da pesquisa 30 voluntários do sexo masculino, deficientes visuais, com idade entre 16 e 60 anos distribuídos em três grupos, a saber, irregularmente ativos (G1), praticantes de natação 2 vezes por semana (G2); e praticantes de natação 5 vezes na semana (G3). Foram aplicados os questionários relacionados ao padrão de sono (Pittsburgh), sonolência (Epworth), cronotipo (Horne e Östberg) e qualidade de vida (SF-36). Resultados: Os principais resultados mostraram que o G3 apresentou melhor qualidade de sono, bem como maior eficiência do sono com relação aos outros dois grupos. Além disso, o G1 demonstrou piores escores para qualidade de vida com relação ao G3 nos domínios estado geral de saúde, vitalidade e aspecto social. Conclusão: Dessa forma, podemos sugerir que a frequência maior na prática da atividade física (natação) atuou positivamente sobre a qualidade do sono e a qualidade de vida de pessoas com deficiência visual. Nível de evidência III, Estudo de caso controle .

Evaluation of Sleep Quality and Daytime Sleepiness in Dentistry Students

Abstract Objective: To evaluate sleep quality and excessive daytime sleepiness in undergraduate dentistry students. Material and Methods: This research is characterized as an observational study of transversal type, having analysed undergraduate students in dentistry from a public university in the State of Pernambuco, Brazil. The sample consisted of 325 students enrolled between the 1st and 10th academic semester. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), while excessive daytime sleepiness was analysed through the Epworth Sleepiness Scale (ESS). The t-Student and Mann-Whitney tests were used for the numerical values, with the F-test (ANOVA) or the Kruskal-Wallis test being used to compare more than two categories. Results: It was observed that 71.1% of students presented a poor sleep quality, with more than half of the students exhibiting excessive daytime sleepiness (58.1%). A relationship between sleep quality and the academic semester was verified. However, gender and age were not associated with sleep quality or with excessive daytime sleepiness. Conclusion: A high prevalence of poor sleep quality and excessive daytime sleepiness was observed among undergraduate students in dentistry. The data suggest that the undergraduate degree in Dentistry can influence the students' quality of sleep, regardless of age or gender.

Standardization of the duty shift in a General Adult Intensive Care Unit / Estandarización del paso de turno en Unidad de Terapia Intensiva General Adulto / Padronização da passagem de plantão em Unidade de Terapia Intensiva Geral Adulto

ABSTRACT Objective: To standardize the duty shift in a General Adult Intensive Care Unit. Method: Multi-method research, which used action research, descriptive study and content validation. Participants included 11 care nurses and 4 intensive care nurses. For the data collection, a semi-structured questionnaire was used, meetings with participants and validation with specialists. In this step, the modified online Delphi Technique was used. For data treatment, the Discourse of the Collective Subject (DCS) was used, descriptive analysis and Content Validity Index. Results: Three DCS on duty change, a Standard Operating Procedure (SOP) and an information registration instrument, validated in appearance, clarity, suitability and content. Final considerations: The instrument assists in the transmission of information, strengthening patient safety and SOP will outline the shift, these tools can improve ICU shift, minimizing the risks of communication failure.

RESUMEN Objetivo: Padronizar el paso de turno en una Unidad de Terapia Intensiva General Adulto. Método: Investigación multiuso, que utilizó la investigación-acción, el estudio descriptivo y la validación de contenido. Los participantes fueron 11 enfermeros asistenciales y cuatro enfermeros especialistas en cuidados intensivos. Para la recolección de datos se aplicó un cuestionario semiestructurado, reuniones con participante y validación con especialistas. En esta etapa, se utilizó la Técnica Delphi online modificada. Para el tratamiento de los datos, se empleó el Discurso del Sujeto Colectivo (DSC), análisis descriptivo e Índice de Validez de Contenido. Resultados: Tres DSC sobre pasaje de turno, un Procedimiento Operativo Estándar (POP) y un instrumento de registro de informaciones, validado en apariencia, claridad, adecuación y contenido. Consideraciónes finales: El instrumento auxilia en la transmisión de informaciones, fortaleciendo la seguridad del paciente y el POP va delineando el paso de turno, esas herramientas pueden mejorar el paso de turno de la UTI, minimizando los riesgos de fallas de comunicación.

RESUMO Objetivo: Padronizar a passagem de plantão em uma Unidade de Terapia Intensiva Geral Adulto. Método: Pesquisa multimétodo, que utilizou a pesquisa-ação, o estudo descritivo e a validação de conteúdo. Os participantes foram 11 enfermeiros assistenciais e quatro enfermeiros especialistas em cuidados intensivos. Para a coleta de dados foi aplicado um questionário semiestruturado, reuniões com participante e validação com especialistas. Nesta etapa, utilizou-se a Técnica Delphi online modificada. Para tratamento dos dados, empregou-se o Discurso do Sujeito Coletivo (DSC), análise descritiva e Índice de Validade de Conteúdo. Resultados: Três DSC sobre passagem de plantão, um Procedimento Operacional Padrão (POP) e um instrumento de registro de informações, validado em aparência, clareza, adequabilidade e conteúdo. Considerações finais: O instrumento auxilia na transmissão de informações, fortalecendo a segurança do paciente e o POP vai delinear a passagem de plantão, essas ferramentas podem melhorar a passagem de plantão da UTI, minimizando os riscos de falhas de comunicação.

Características polisomnográficas nocturnas y otras variables relacionadas, en pacientes adultos mayores / Nocturnal polysomnbnographic characteristics and other related variables in elderly patients

Se cree que los ancianos necesitan dormir menos. Sin embargo, no es la necesidad de sueño sino la capacidad de dormir lo que disminuye con la edad, en paralelo a la mayor prevalencia de enfermedades cardiovasculares o metabólicas, o de depresión. Poco se ha descripto sobre los hallazgos polisomnográficos de esta población. En el presente estudio analizamos los hallazgos polisomnográficos en pacientes mayores de 65 años. Se realizó un estudio descriptivo a partir del análisis de una base de datos de 551 pacientes mayores de 65 años evaluados entre junio de 2013 y diciembre de 2014. Todos los sujetos se realizaron una polisomnografía (PSG) nocturna de 6 horas de duración. Las variables analizadas fueron: latencia de sueño (LS), eficacia de sueño (ES), latencia de fase REM (Lat R), % de R, índice de apneas hipopneas (IHA) y movimientos periódicos de piernas durante el sueño (PLMS). Se dividió la población en 3 grupos: G1: de 65 a 70 años; G2: 71 a 75; G3: mayor de 75 años. Se analizaron los datos de la serie general y las diferencias intergrupos. El IHA se incrementó con la edad y resultó más severo en los pacientes mayores de 75 años en relación con el grupo de menor edad. El incremento del IAH no se asoció a un incremento del índice de masa corporal ni a mayor somnolencia diurna. (AU)

It is believed that the elderly need less sleep. However, it is not the need for sleep but the ability to sleep that decreases with age, in parallel to the increasing prevalence of cardiovascular or metabolic disease, or depression. Little has been described about the polysomnographic findings of this population, hypothesizing that there are several alterations that prematurely corrected could improve the quality of life as the years go by. We analyzed the polysomnographic findings in patients over 65 years of age. A descriptive study was carried out based on the analyses of a database of 551 patients over 65 years of age evaluated between June 2013 to December 2014. All subjects underwent nocturnal PSG of 6 hours duration. The polysomnographic variables analyzed were: sleep latency (LS), sleep efficiency (ES), latency R phase (Lat R), % R, Apneas Hypoapneas Index (AHI) and Periodic Limb Movements of Sleep (PLMS). The population was divided into 3 groups: G1: from 65 to 70 years G2: 71 to 75, G3 greater than 75. AHI increased with age, being more severe in patients over 75 years of age in relation to the younger age group. The increase in AHI was not associated with an increase in Body Mass Index (BMI) or greater daytime sleepiness. (AU)

Análise da qualidade do sono em Mulheres climatéricas ativas e sedentárias / Analysis of sleep quality in active and sedentary climatric Women

Introdução: O climatério é caracterizado pelo estado fisiológico do hipoestrogenismo, com a interrupção definitiva dos ciclos menstruais. Objetivo: Analisar a qualidade do sono em mulheres climatéricas ativas e sedentárias. Métodos: A pesquisa foi realizada com 60 mulheres climatéricas, onde foram dividas em três grupos, 20 praticantes de exercício aeróbico, 20 que realizam treinamento resistido e 20 sedentárias, a coleta de dados foi realizada por meio de dois questionários, para analise dos dados foi usado o teste Pearson Qui-quadrado com intervalo de confiança em 95% e significância estabelecida em p< 0,05. Resultados: A médiade idade dos grupos de 49,25±0,97 a 53,4±1,08. Os resultados apontam uma diferença significativa quando comparados os grupos a sintomatologia, porém com o questionário de PSQI não houve diferenças significativas. Conclusão: O estudo mostrou que comparadas quanto a sintomatologia, as mulheres praticantes de exercícios anaeróbicos obtiveram um melhor resultado, entretanto em relação a qualidade do sono precisa-se de mais estudo. (AU)

Introduction: The climacteric is characterized by the physiological state of hypoestrogenism, with the definitive interruption of the menstrual cycles . Objective: To analyze sleep quality in active and sedentary climacteric women. Methods: The research was carried out with 60 climacteric women, divided into three groups, 20 aerobic exercise practitioners, 20 who underwent resistance training and 20 sedentary women. Data collection was done through two questionnaires. Used the Pearson Chi-square test with 95% confidence interval and significance set at p <0.05. Results: The mean age of the groups ranged from 49.25 ± 0.97 to 53.4 ± 1.08. The results point to a significant difference when comparing the groups with the symptomatology, but with the PSQI questionnaire there were no significant differences. Conclusion: The study showed that compared to symptomatology, women practicing anaerobic exercises obtained a better result, however, in relation to sleep quality, more study is needed. (AU)

Abordagem não-farmacológica na cefaleia do tipo tensional: efeitos da hidroterapia sobre a dor e a qualidade de vida / Non-pharmacological approach in tension-type headache: effects of hydrotherapy on pain and quality of life

Há poucos relatos na literatura de abordagens não-farmacológicas para o tratamento da cefaleia do tipo tensional (CTT), problema comum que gera impacto negativo na vida dos portadores, e nenhum sobre o protocolo de hidroterapia proposto. O objetivo do estudo foi verificar os efeitos da hidroterapia sobre a intensidade da dor e frequência das crises, bem como sua interferência na qualidade de vida dos portadores. Um protocolo de hidroterapia com 12 sessões de 60 minutos em piscina aquecida a 31º, contemplando aquecimento, alongamentos, exercícios aeróbicos e exercícios de relaxamento foi utilizado em três indivíduos com diagnóstico médico de CTT. A terapia promoveu melhora no Headache Impact Test (HIT-6), na Es- cala de sonolência de Epworth e no questionário de disfunção temporomandibular (RDC/TMD). Através do diário de dor de cabeça foi verificada redução da frequência da CTT nos três indivíduos durante a terapia e essa redução foi mantida após trinta dias do tratamento. Um indivíduo apresentou diminuição da intensidade da dor durante e após 30 dias do tratamento. O estudo sugere que a hidroterapia pode ser indicada para diminuir a frequência da CTT, bem como para melhorar a qualidade de vida dos portadores.

There are few reports in the literature of non-pharmacological approaches for the treatment of tension-type headache, common problem that generates significant negative impact on quality of life of patients, and none about therapeutic protocol proposed by this study. The aim of the study was to assess the effects of hydrotherapy on the reduction of pain intensity and frequency of crises and their interference in the quality of life of patients. A hydrotherapy protocol with 12 sessions of 60 minutes in pool heated to 31 degrees contemplating heating, stretching, aerobic and relaxation exercise was applied in three patients with clinical diagnosis of tension-type headache. The therapy promoted improvement in the Headache Impact Test (HIT-6), in the Epworth Sleepiness Scale and in the Temporomandibular Dysfunction Questionnaire (RDC / TMD). Through of a daily of headache a reduction in the frequency of tension-type headache was observed in the three individuals during therapy and this reduction was maintained after thirty days of treatment. An individual had a decrease in pain intensity during and after 30 days of treatment. The study suggests that hydrotherapy can be indicated to decrease the frequency of tension-type headache, as well as to improve the quality of life of individuals.

Education in children's sleep hygiene: which approaches are effective? A systematic review, / Educação em higiene do sono na infância: quais abordagens são efetivas? Uma revisão sistemática da literatura,

Aim: To analyze the interventions aimed at the practice of sleep hygiene, as well as their applicability and effectiveness in the clinical scenario, so that they may be used by pediatricians and family physicians for parental advice. Source of data: A search of the PubMed database was performed using the following descriptors: sleep hygiene OR sleep education AND children or school-aged. In the LILACS and SciELO databases, the descriptors in Portuguese were: higiene E sono, educação E sono, educação E sono E crianças, e higiene E sono E infância, with no limitations of the publication period. Summary of the findings: In total, ten articles were reviewed, in which the main objectives were to analyze the effectiveness of behavioral approaches and sleep hygiene techniques on children's sleep quality and parents' quality of life. The techniques used were one or more of the following: positive routines; controlled comforting and gradual extinction or sleep remodeling; as well as written diaries to monitor children's sleep patterns. All of the approaches yielded positive results. Conclusions: Although behavioral approaches to pediatric sleep hygiene are easy to apply and adhere to, there have been very few studies evaluating the effectiveness of the available techniques. This review demonstrated that these methods are effective in providing sleep hygiene for children, thus reflecting on parents' improved quality of life. It is of utmost importance that pediatricians and family physicians are aware of such methods in order to adequately advise patients and their families. .

Objetivo: Avaliar as intervenções visando práticas de higiene do sono em crianças, sua aplicabilidade e efetividade na prática clínica, para que as mesmas possam ser utilizadas na orientação dos pais pelos pediatras e médicos de família. Fonte dos dados: Foi realizada busca na base de dados da Pubmed utilizando os descritores sleep hygiene OR sleep education AND child or school-aged, e nas bases Lilacs e Scielo, com as seguintes palavras-chave: higiene E sono, educação E sono, educação E sono E crianças, e higiene E sono E infância, não tendo sido limitado o período de busca. Síntese dos dados: Foram revisados 10 artigos cujos objetivos eram analisar efetividade de abordagens comportamentais e de técnicas de higiene do sono sobre a qualidade do sono das crianças e na qualidade de vida dos pais. Foram utilizadas uma ou mais das seguintes técnicas: rotinas positivas, checagem mínima com extinçcão sistemática e extinção gradativa ou remodelamento do sono, bem como diários do padrão de sono. Todas as abordagens apresentaram resultados positivos. Conclusões: Apesar de a abordagem comportamental no manejo do sono na faixa etária pediátrica ser de simples execuçcão e adesão, existem poucos estudos na literatura que avaliaram sua efetividade. Os estudos revisados evidenciaram que estas medidas são efetivas na higiene e refletem em melhoria na qualidade de vida dos pais. É de fundamental importância os pediatras e médicos de família conhecerem estas abordagens, para que possam oferecer orientacções adequadas a seus pacientes. .

Autoestima y autocuidado en los adultos mayores que asisten al Programa del Adulto Mayor en el Centro de Salud Conde de la Vega. Lima 2012 / Self-esteem and self-care in older adults who attend the Older Adult Program at the Health Center Conde de la Vega. Lima 2012

El objetivo del estudio fue determinar la autoestima y los conocimientos sobre autocuidado en el adulto mayor que asiste al programa del adulto mayor en el C.S. Conde de la Vega Baja. Material y Método: El estudio fue de nivel aplicativo, tipo cuantitativo, método descriptivo de corte transversal. La muestra estuvo conformada por 35 adultos mayores. La técnica fue la entrevista y los instrumentos, la escala de autoestima de Rosemberg y un formulario tipo cuestionario aplicado previo consentimiento informado. Resultados: Del 100 por ciento (30), 57 por ciento (17), tienen autoestima baja, 33 por ciento (10) media, y 10 por ciento (3) alta. En cuanto a los conocimientos, 53 por ciento (16) no conoce y 47 por ciento (14) conoce, en la dimensión biológica 53 por ciento (16) no conocen y 47 por ciento (14) conocen, y en la dimensión psicosocial 73 por ciento (22) conocen y 27 por ciento (08) no conocen. Conclusiones: La mayoría de los adultos mayores tienen un nivel de autoestima de baja a media referido a que; se sienten inútiles a veces, no tienen por qué sentirse orgullosos y se sienten fracasados, seguido de un mínimo porcentaje alto ya que sienten que tienen buenas cualidades y valen igual que los demás. En cuanto a los conocimientos el mayor porcentaje de los adultos mayores no conocen sobre el autocuidado en el sueño, aspectos nutricionales y la importancia de las relaciones familiares y sociales; lo que conocen esta dado por los cuidados de la piel y anexos, la actividad física, y el tiempo libre...

The objective of the study was to determine the self-esteem and knowledge about self-care in the elderly that assists the elderly program in the C.S. Conde de la Vega Baja. Material and method: The study was of application level, quantitative, descriptive cross-sectional method. The sample was formed by 35 seniors. The technique was the interview and the instruments, the Rosenberg self-esteem scale and a standard questionnaire applied prior informed consent form. Results: 100 per cent (30), 57 per cent (17), have low self-esteem, 33 per cent (10) media, and 10 per cent (3) high. In terms of the knowledge, 53 per cent (16) does not know and 47 per cent (14) known, not known at dimension biological 53 per cent (16) and 47 per cent (14) known, and known in dimension psychosocial 73 per cent (22) and 27 per cent (08) do not know. Conclusions: The majority of older adults have a level of self-esteem of low to medium referred to; useless feel sometimes, have no why be proud and unsuccessful, they are followed by a minimum percentage since they feel that they have good qualities and are worth the same as others. In terms of the knowledge the highest percentage of older adults do not know about self-care in sleep, nutrition and the importance of family and social relations; what know this given by the care of the skin and annexes, physical activity, and free time...

Sueño en escolares y adolescentes, su importancia y promoción a través de programas educativos / Sleep habits in pediatrics: education and behavioral approach programs

La alta prevalencia de trastornos del sueño en los niños constituye un tema transversal del cuidado de la población. Esto ha hecho emerger la necesidad de ampliar la gama de programas educativos, que incentiven la formación de hábitos saludables, basados en la higiene del sueño y en las conductas autorregulatorias de niños y adolescentes. El objetivo de esta revisión es los principales factores que permiten diseñar programas educativos e intervenciones, con la finalidad de mejorar y prevenir el surgimiento de alteraciones más complejas y de difícil resolución.

The high prevalence of sleep disorders in children constitutes a cross curricular issue regarding people care, resulting in the need to increase the range of educational programs that encourage the formation of healthy habits, based on sleep hygiene and self-regulatory behaviors in children and adolescents. The aim of this study focuses on the main factors for the design of educational programs and interventions that improve and prevent complex conditions that are difficult to solve.

Influencia de la rehabilitación cardíaca sobre la tasa de re-hospitalización en pacientes con infarto agudo de miocardio, Santander, Colombia / The influence of cardiac rehabilitation on acute myocardial infarction patients' readmission rate in Santander, Colombia

Objetivo Estimar el efecto de la rehabilitación cardiaca (RC) pos-infarto, según sus niveles de intervención, sobre las tasas de re-hospitalización. Métodos Estudio de cohorte prospectiva de pacientes con diagnóstico de IAM. Se obtuvieron datos sobre gravedad del infarto, antecedentes, historia médica, evolución intrahospitalaria, clasificación Killip, estancia y condición de egreso. A través de la historia clínica electrónica y mediante contacto telefónico se constató si el paciente recibió RC y cuáles fueron sus componentes; el seguimiento se extendió hasta por un año. Resultados Se incluyeron 96 pacientes de ambos sexos con IAM. En 72 se contó con información sobre RC; 5 de los cuales recibieron RC basada únicamente en actividad física; 49 pacientes recibieron una RC más completa que integró actividad física, educación, psicología y nutrición; 18 pacientes no recibieron RC. Durante el seguimiento, se registraron 10 nuevas hospitalizaciones y una muerte. En un modelo de Poisson, los pacientes cuya RC se basó sólo en la actividad física presentaron una tasa de re-hospitalizaciones significativamente mayor que la de los pacientes que recibieron un esquema completo de RC (Razón de tasas: 5,89; IC 95 %:1,14-30,49; ρ=0,04). Conclusiones La RC debe tener un enfoque multidisciplinario, que además del componente físico, incluya el psicológico, nutricional y educativo.

Objective Estimating the effect of post-infarction cardiac rehabilitation (CR) on readmission/re-hospitalization rates according to intervention level. Method This was a prospective cohort study of patients diagnosed as suffering acute myocardial infarction (AMI). Data concerning infarction severity, previous illness, medical history, hospital course, Killip classification, length of hospital stay and condition on discharge. Medical records and telephone contact were used to confirm whether a patient had received CR and ascertain pertinent components. Follow-up was extended to one year. Results 96 AMI patients of both genders were included; information about CR was available for 72 of them,5 of whom had received CR based only on physical activity. 49 patients received complete CR based on education, physical activity, psychological and nutritional assessment. 18 patients had not received CR. One death and 10 new admissions/hospitalizations were recorded during follow-up. A Poisson regression model showed that patients who had received CR based only on physical activity presented significantly higher re-hospitalization rates than patients who had received a complete CR scheme (rate ratio 5.89:1.14-30.4995 % CI; p=0.04). Conclusions A multidisciplinary approach must bead opted to CR involving physical activity, education and psychological and nutritional assessment.

Trastornos del sueño en el paciente adulto hospitalizado / Disorders of sleep in the hospitalized adult patient

Hospitalized adult patients frequently have sleep complaints. The majority of studies have principally focused in ICU patients. However, many medical and surgical disorders can disrupt the normal sleep architecture. Sleep disorders in hospitalized patients are susceptible to be successfully treated with hypnotics and control of ambient factors. We reviewed papers published in the Medline between 1997 – 2012, those considered relevant are be discussed in this review.

Trastornos del sueño en los pacientes críticos / Sleep disorders in critically ill patients

Sleep disorders are common in critically ill patients, and its consequences still insufficiently clarified. An environment with multiple noxious stimuli, light and hearing, admission for severe acute illness with multisystem disease, and the need for drugs that can disrupt sleep physiology, lead to this situation. We will review the epidemiology and risk factors for these disorders, and its possible consequences. Finally we discuss potential strategies for prevention of sleep disorders in this patient population.

Physical activity attenuates neuropsychiatric disturbances and caregiver burden in patients with dementia

INTRODUCTION: A significant benefit from physical activity has recently been described in some patients who suffer from neurodegenerative diseases. OBJECTIVE: To assess the effects of physical activity on neuropsychiatric disturbances in demented patients and on the mental burden of their caregivers. METHODS: Assisted by a public geriatric psychiatry clinical unit, we studied 59 patients with dementia. Patients were divided into three groups according to their diagnosis and level of physical activity. Data were assessed through a semi-structured interview. Patients were evaluated with the Neuropsychiatric Inventory, the Mini-Sleep Questionnaire and the Baecke Questionnaire. The data were statistically analyzed using the Mann-Whitney U test and linear regression, with the level of significance set at 5 percent. RESULTS: Patients with Alzheimer's or vascular dementia who engaged in physical activity had fewer neuropsychiatric symptoms than those who did not. When compared to the control group, the caregivers of patients with vascular dementia who engaged in physical activity had a reduced burden. CONCLUSION: The regular practice of physical activity seems to contribute to a reduction in neuropsychiatric symptoms in dementia patients and to attenuate the burden of the caregivers of those patients.

Transtornos do sono / Sleeping disorders

Os autores ressaltam a importância do clínico em conhecer e diagnosticar os principais transtornos do sono, bem como seu tratamento. É abordado, em linhas gerais, o diagnóstico e tratamento da insônia, das principais parassônias, da apneia obstrutiva do sono, da síndrome das pernas inquietas e da narcolepsia.

The Relationship of Quality of Sleep, Depression, Late-Life Function and Disability (LLFDI) in Community-Dwelling Older Women with Urinary Incontinence / 간호학회지

PURPOSE: The purpose of this study was to investigate the relationships among quality of sleep, depression, late-life function and disability in community-dwelling older women with urinary incontinence. METHODS: A stratified random sampling method was conducted to recruit participants from May 10 to August 17, 2007. Data were collected by questionnaires, which were constructed to include lower urinary tract symptoms, quality of sleep, depression, and late-life function and disability in 128 community-dwelling older women. RESULTS: The major findings of this study were as follow: 1) 56.3% of participants belonged to urinary incontinence group. 2) There were significant relationships between depression and sleep latency, sleep duration, daytime dysfunction, quality of sleep, function component, frequency dimension, and limitation dimension. 3) Depression was significantly associated with frequency dimension, limitation dimension in capability which explained 44% of variance in depression. CONCLUSION: These results may contribute to a better understanding of sleep quality, depression, latelife function and disability in the community-dwelling older women with urinary incontinence. Therefore, health programs for prompting older women's health should be planned based on results of the study.

Alteraciones y hábitos de sueño en una muestra de escolares chilenos / Sleep disturbance and sleep practices in a chilean school aged population

El presente trabajo tiene como propósito determinar condiciones generales, hábitos y problemas de sueño, en una muestra de un grupo de estudiantes de una escuela municipal de Chile, ya que no existen datos precisos en nuestro medio sobre el tópico. Se realiza un estudio descriptivo correlacional en una muestra de 129 escolares de 5 a 8 básico de una escuela de nivel socioeconómico medio bajo de Santiago de Chile. Se extrajeron datos de una encuesta precodificada, repartida por el profesor jefe tanto a sus alumnos como a su grupo familiar. Los resultados fueron los siguientes: Edad promedio: 12.3 años. 54 por ciento varones 68.2 por ciento mantiene una alta estimulación electrónica en su dormitorio. 7 por ciento tiene computador en su pieza. 16 por ciento comparte su cama. 43 por ciento ocupa su propia cama desde antes del primer año de vida. 6 por ciento no permanece en su cama durante la noche. 54 por ciento se acuesta después de las 32 hrs. Entre las rutinas más frecuentes previo dormir: ver televisión: 23 por ciento, comer: 15 por ciento y rezar: 35 por ciento. En 34.9 por ciento de las familias algún miembro presenta alteraciones del sueño y 11.6 por ciento de los padres ingieren algún medicamento para dormir. 44.2 por ciento presentan alteraciones de sueño. Insomnio: 34.9 por ciento. Hipersomnia diurna: 67.2 por ciento. Pesadillas: 25.2 por ciento. Terrores nocturnos: 20.2 por ciento. Sonambulismo: 10.1 por ciento. Bruxismo 5.9 por ciento. Enurisis: 5 por ciento. Entre las variables que se asocian a mayor riesgo de alteraciones de sueño están las condiciones en que el niño duerme y ver televisión previo al dormir. Voluntariamente, 11 alumnos consultaron médico, en el CEMS (Centro de estudios médicos del sueño). 6/11 por insomnio de conciliación y 4/11 por parasomnias. En la mayoría (8/11), existían problemas ambientales hogareños. El problema de sus calificaciones escolares fue 5.1. El promedio de horas dormidas fue de 7.6. Los datos de trastornos de sueño obtenidos son mayores a los descritos en otras publicaciones internacionales, probablemente debido a que en su gran mayoría hábitos y condiciones de dormir son inadecuadas. Se insinúa una estrecha relación entre los trastornos de sueño y rendimiento escolar.

Requirements for the protection against aircraft noise.

In preparation of the revised edition of the Air Traffic Noise Act the Federal Environmental Agency formulated targets for aircraft noise control. They were prepared oriented to the Federal Immission Control Act. The assessment periods were chosen analogously to the regulations on other traffic noise sources (rail traffic, road traffic). The control targets cover the following affected areas * aural, extra-aural health * night's sleep * annoyance * communication * recreation Considerable nuisance can be avoided by limiting the exposure to aircraft noise(outside) to equivalent levels below 55 dB(A) by day and 45 dB(A) at night, and impairment of health can be avoided by limiting the exposure to aircraft noise (outside) to equivalent levels below 60 dB(A) by day and 50 dB(A) at night.

Dificultad para conciliar el sueño y despertares nocturnos como motivo de consulta pediátrica / Sleep-onset difficulties and nightwaking as a pediatric consultation

El objetivo de este estudio fue describir algunos de los trastornos del sueño como la dificultad para conciliarlo y los despertares nocturnos durante la infancia,sus asociaciones causales,evaluar la respuesta a un tratamiento conductual y establecer pautas de prevencion y manejo.Población,material y métodos.Se estudiaron 56 niños sanos,de 6 a 60 meses de edad,durante el período comprendidos entre enero de 1996 y enero de 1998,con la presencia de ambos padres durante las consultas.La valoración fue interdisciplinaria entre Pediatría y Psicopatología.Se realizó un diario de sueño de 15 días durante la etapa diagnóstica y se estableció una estrategia de tratamiento.Resultados.El sexo de los niños,el número de paridad y la ubicación del paciente dentro de su familia no constituyeron un factor predisponente para la aparición de estos trastornos.Tampoco se realcionaron con los antecedentes perinatales,patológicos(bronquitis obstructiva recidivante,otitis media aguda a repetición,reflujo gastroesofágico,etc)no con el antecedente de cólicos del lactante.Constituyeron factores condicionantes la falta de rutina y de rituales de sueño asociados a inadecuada percepción y a falta de conocimientos maternos acerca de algunas necesidades de los hijos.La edad también fue determinate como factor pronóstico(a menor edad del niño mayor capacidad de adaptación a las diferentes pautas,tanto de prevención como de tratamiento)Conclusión.La dificultad para conciliar el sueño y los despertares nocturnos constituyen motivos frecuentes de consulta en pediatría.En los niños sanos,los antecedente personales y las enfermedades previas no tendrán relevancia en la aparición de estos trastornos,La inadecuada información de los padres respecto a las distintas etapas madurativas del sueño es el factor más determinante en la generación o perpetuación de la dificultad para conciliar el sueño y los despertares nocturnos,como trastornos del sueño en los menores de 5 años.Cuando más temprana sea la intervención por parte de los pediatras como educadores respecto de la maduración del sueño y sus distintas asociaciones a lo largo de los primeros años de la vida de un niño sano,mayores serán las posibilidades de los padres para actuar de manera exitosa,fundamentalmente en la prevención y eventualmente en el tratamiento de estos trastornos del sueño