Modulating Influence of State Anxiety on the Effect of Midazolam on Postsurgical Pain.

Anxiety contributes to postsurgical pain, and midazolam is frequently prescribed preoperatively. Conflicting results have been described concerning the impact of midazolam on pain. This study aims to evaluate the effect of systemic midazolam on pain after open inguinal hernia repair, clarifying its relationship with preoperative anxiety. A prospective observational cohort study was conducted in three Portuguese ambulatory units between September 2018 and March 2020. Variable doses of midazolam were administered. Postsurgical pain was evaluated up to three months after surgery. We enrolled 306 patients and analyzed 281 patients. The mean preoperative anxiety Numeric Rating Scale score was 4 (3) and the mean Surgical Fear Questionnaire score was 22 (16); the mean midazolam dose was 1.7 (1.1) mg with no correlation to preoperative anxiety scores. Pain ≥4 was present in 67% of patients 24 h after surgery and in 54% at seven days; at three months, 27% were classified as having chronic postsurgical pain. Preoperative anxiety correlated to pain severity at all time points. In multivariable regression, higher midazolam doses were associated with less pain during the first week, with no apparent effect on chronic pain. However, subgroup analyses uncovered an effect modification according to preoperative anxiety: the decrease in acute pain occurred in the low-anxiety patients with no effect on the high-anxiety group. Inversely, there was an increase in chronic postsurgical pain in the very anxious patients, without any effect on the low-anxiety group. Midazolam, generally used as an anxiolytic, might impact distinctively on pain depending on anxiety.

Seroprevalence of SARS-CoV-2 and assessment of epidemiologic determinants in Portuguese municipal workers.

OBJECTIVES: To assess the seroprevalence of SARS-CoV-2 antibodies in municipal employees of Northern Portugal during the first pandemic wave (May-June 2020) and its association with potentially related risk factors for infection. MATERIAL AND METHODS: The authors assessed municipal employees of 2 cities in Northern Portugal, in whom serological tests to SARS-CoV-2 and an epidemiological survey were applied. The authors assessed the proportion of individuals presenting IgM and/or IgG antibodies to SARS-CoV-2, and evaluated the association between having positive serological test results, epidemiologic variables and clinical presentations. Reported symptoms were evaluated on their sensitivity, specificity, and predictive values. RESULTS: The authors assessed 1696 employees, of whom 22.0% were firefighters, 10.4% were police officers, 10.3% were maintenance workers, and 8.1% were administrative assistants. The seroprevalence of SARS-CoV-2 infection was 2.9% (95% CI: 2.1-3.7%). Administrative assistants comprised the professional group with highest seroprevalence of SARS-CoV-2 (OR = 1.9 in the comparison with other occupational groups, 95% CI: 0.8-4.3, p = 0.126). The seroprevalence of SARS-CoV-2 infection among those who were in direct contact with COVID-19 patients in their professional activity was 3.9%, compared to 2.7% among those who were not in direct contact with such patients (OR = 1.5, 95% CI: 0.8-2.8, p = 0.222). The highest risk of infection was associated with the presence of a confirmed SARS-CoV-2 infection in the household (OR = 17.4, 95% CI: 8.3-36.8, p < 0.001). Living with a healthcare professional was not associated with a higher risk of infection (OR = 1.0, 95% CI: 0.4-2.5, p = 0.934). Anosmia/ dysgeusia was the symptom with the highest positive predictive value (52.2%, 95% CI: 31.8-72.6, p < 0.001) and specificity (99.3%, 95% CI: 98.9-99.7, p < 0.001), while cough was the most prevalent symptom among SARS-CoV-2 seropositive participants (36%). CONCLUSIONS: The authors observed a SARS-CoV-2 seroprevalence of 2.9% among assessed municipal employees. Anosmia/dysgeusia was the COVID-19 symptom which displayed the highest positive predictive value and specificity. Int J Occup Med Environ Health. 2022;35(3):297-307.

Informe de tristeza/depresión, nerviosismo/ansiedad y problemas de sueño en la población adulta brasileña durante la pandemia de COVID-19 Report on sadness/depression, nervousness/anxiety and sleep problems in the Brazilian adult population during the COVID-19 pandemic

Resumo Objetivo: Analisar a frequência de tristeza, nervosismo e alterações do sono durante a pandemia de COVID-19 no Brasil, identificando os segmentos demográficos mais afetados. Métodos: Estudo transversal, com questionário aplicado via web a adultos e idosos, coletando informações sobre condições de vida, saúde e comportamento. Foram estimadas prevalências e razões de prevalências ajustadas por idade e sexo. Resultados: De 45.161 brasileiros respondentes, verificou-se que, durante a pandemia, 40,4% (IC95% 39,0;41,8) se sentiram frequentemente tristes ou deprimidos, e 52,6% (IC95% 51,2;54,1) frequentemente ansiosos ou nervosos;43,5% (IC95% 41,8;45,3) relataram início de problemas de sono, e 48,0% (IC95% 45,6;50,5) problema de sono preexistente agravado. Tristeza, nervosismo frequentes e alterações do sono estiveram mais presentes entre adultos jovens, mulheres e pessoas com antecedente de depressão. Conclusão: As elevadas prevalências encontradas indicam a necessidade de garantir a provisão de serviços de atenção à saúde mental e à qualidade do sono, adaptados ao contexto pandêmico. Resumen Objetivo: Analizar la frecuencia de tristeza, nerviosismo y trastornos del sueño durante la pandemia de COVID-19 en Brasil. Métodos: Estudio transversal, con cuestionario aplicado a adultos y ancianos vía web, que recopiló información sobre las condiciones de vida, la salud y los comportamientos de salud. Se estimaron prevalencias y razones de prevalencia que se ajustaron por edad y sexo. Resultados: Con datos de 45.161 encuestados, se encontró que el 40,4% (IC95% 41,4;46,7) de los brasileños a menudo se sentía triste o deprimido y el 52,6% (IC95% 51,2;54,1) a menudo ansioso o nervioso;el 43,5% (IC95% 41,8;45,3) comenzó a tener trastornos de sueño y el 48,0% (IC95% 45,6;50,5) tuvo trastorno de sueño previo agravado. La tristeza, el nerviosismo y los trastornos del sueño fueron mucho más intensos en adultos jóvenes, mujeres y personas con antecedentes de depresión. Conclusión: Las altas prevalencias encontradas indican la necesidad de garantizar la provisión de servicios a la salud mental y a la calidad del sueño, de forma adaptada al contexto pandémico. Objective: To analyze the frequency of sadness, nervousness, and sleep disorders during the COVID-19 pandemic in Brazil, identifying the most affected demographic segments. Methods: This was a cross-sectional study using an online questionnaire answered by adults and elderly people to collect information on living conditions, health and health-related behaviors. Prevalence rates and prevalence ratios adjusted for age and sex were estimated. Results: The data on 45,161 Brazilian respondents showed that during the pandemic 40.4% (95%CI 39.0;41.8) frequently felt sad or depressed and 52.6% (95%CI 51.2;54.1) frequently felt anxious or nervous;43.5% (95%CI 41.8;45.3) reported the onset of sleep problems and 48.0% (95%CI 45.6;50.5) had a prior sleep problem that had become worse. Frequent sadness and nervousness, as well as change in sleep patterns were higher in young adults, women and those with a history of depression. Conclusion: The high prevalence found indicates the need to guarantee the provision of services for mental health and quality of sleep that are adapted to the pandemic context.

Report on sadness/depression, nervousness/anxiety and sleep problems in the Brazilian adult population during the COVID-19 pandemic. / Relato de tristeza/depressão, nervosismo/ansiedade e problemas de sono na população adulta brasileira durante a pandemia de COVID-19.

OBJECTIVE: To analyze the frequency of sadness, nervousness, and sleep disorders during the COVID-19 pandemic in Brazil, identifying the most affected demographic segments. METHODS: This was a cross-sectional study using an online questionnaire answered by adults and elderly people to collect information on living conditions, health and health-related behaviors. Prevalence rates and prevalence ratios adjusted for age and sex were estimated. RESULTS: The data on 45,161 Brazilian respondents showed that during the pandemic 40.4% (95%CI 39.0;41.8) frequently felt sad or depressed and 52.6% (95%CI 51.2;54.1) frequently felt anxious or nervous; 43.5% (95%CI 41.8;45.3) reported the onset of sleep problems and 48.0% (95%CI 45.6;50.5) had a prior sleep problem that had become worse. Frequent sadness and nervousness, as well as change in sleep patterns were higher in young adults, women and those with a history of depression. CONCLUSION: The high prevalence found indicates the need to guarantee the provision of services for mental health and quality of sleep that are adapted to the pandemic context.