Risk factors and clinical profile of autism spectrum disorder in southern Brazil.

In Brazil, as in other countries, it is expected a significant variation of epidemiological and clinical characteristics among individuals with autism spectrum disorder (ASD). This study was performed to explore maternal risk factors and clinical characteristics of children with ASD in a population located in southern Brazil. Data were collected from medical records and analyzed to explore biomarkers associated with ASD. Out of 321 children with ASD, 86.5% were males with a male-to-female ratio of 5.7:1, 50.7% were mild/moderate while 49.3% presented severe ASD. Between the risk factors investigated, gestational infection was significantly associated with severe ASD patients. There was also an association between epilepsy and severe autism. Several gastrointestinal (GI) symptoms were significantly associated with severe ASD. Obesity, followed by lower levels of cholesterol, were also significant factors associated with an ASD diagnosis when compared to age-matched controls. Finally, severe ASD was associated with significantly higher serum serotonin levels when compared to age-matched controls and mild/moderate ASD cases. Our findings demonstrate that our population shares many features associated with ASD around the world, such as GI symptoms, epilepsy, and high serotonin levels. It is worth highlighting the low cholesterol levels associated with obesity as an unusual feature that deserves more attention.

Perfil dos anestesiologistas e os aspectos que interferem na sua satisfação profissional / Profile of anesthesiologists and the aspects that interfere in professional satisfaction

Introdução: Aspectos emocionais, sociais e de remuneração na população de anestesiologistas permanecem parcialmente obscuros. O interesse em reconhecer as características desse grupo pode permitir estratégias de saúde ocupacional que melhorem a qualidade social e profissional dos anestesiologistas. Objetivos: Conhecer o perfil dos médicos anestesiologistas e aspectos que interferem na satisfação profissional. Método: Estudo individual, observacional, transversal, caracterizado como inquérito, de abordagem quantitativa, entre os médicos anestesiologistas do estado do Paraná. Resultados: A taxa de satisfação profissional foi de 82%. A amostra teve predomínio de homens, com percentual de 58,8%, autônomos, com 40,4%, faixa etária entre 30 a 39 anos 45,1%, formados entre 10 a 29 anos, com 47,2% e os que realizam carga horária de 40 a 59 h semanais, com 50,6%. A estrutura de trabalho foi referida como boa em 54,3% das vezes e a remuneração salarial média foi de 10 a 29 mil reais 50,6% dos casos. Os resultados apontam que 75,1% realizam plantões noturnos e 55,8% não dormem bem. Conclusão: A baixa qualidade da estrutura de trabalho, a carga horária elevada, a falta de vínculo empregatício, a baixa remuneração, o sedentarismo, a realização de plantões noturnos e a privação de sono, associados a relação familiar ruim, ambiente e situações estressantes, são fatores que alteram consideravelmente a satisfação profissional do médico anestesiologista, podendo gerar problemas físicos e psicológicos, fazendo com que percam o interesse por atualizarem-se. Isso também faz com que esses profissionais encurtem suas carreiras.

Introduction: Emotional, social and remuneration aspects in the population of anesthesiologists remain partially unclear. The interest in recognizing the characteristics of this group may allow for occupational health strategies that improve the social and professional quality of anesthesiologists. Objectives: To know the profile of anesthesiologists and aspects that interfere with professional satisfaction. Method: Individual, observational, cross-sectional study, characterized as a survey, with a quantitative approach, among anesthesiologists in the state of Paraná. Results: The job satisfaction rate was 82%. The sample had a predominance of men, with a percentage of 58.8%, self-employed, with 40.4%, aged between 30 and 39 years 45.1%, graduated between 10 and 29 years, with 47.2% and those who work 40 to 59 hours per week, with 50.6%. The work structure was referred to as good in 54.3% of the cases and the average salary was between R$ 10,000.00 and 29,000.00 in 50.6% of the cases. The results indicate that 75.1% work night shifts and 55.8% do not sleep well. Conclusion: The low quality of the work structure, the high workload, the lack of employment, low pay, sedentary lifestyle, performing night shifts and sleep deprivation, associated with poor family relationships, environment and stressful situations, these are factors that considerably alter the professional satisfaction of anesthesiologists, and may cause physical and psychological problems, causing them to lose interest in updating themselves. This also causes these professionals to shorten their careers.

Noninvasive hemoglobin monitoring in clinical trials: a systematic review and meta-analysis / Monitorização não invasiva da hemoglobina em ensaios clínicos: uma revisão sistemática e metanálise

Abstract Background and objectives: The measurement of hemoglobin concentration (Hb) by co-oximetry is an innovative technique that offers efficiency and agility in the processing of information regarding the measurement of Hb obtained through continuous, non-invasive and rapid monitoring. Because of this attribute, it avoids unnecessary exposures of the patient to invasive procedures by allowing a reduction in the number of blood samples for evaluation and other unnecessary therapies. It also helps to make decisions about the need for transfusion and how to handle it. The objective of this study is to compare the performance offered to obtain Hb values between the Masimo Corporation (Irvine, CA, USA) instrument and the standard gold tool (laboratory examination). Contents: The study corresponds to a systematic review followed by meta-analysis, which included fully registered full-text clinical trials published from 1990 to 2018. PubMed, Cochrane, Medline, Embase and Web of Science databases were investigated. The mean overall difference found between the non-invasive and invasive methods of hemoglobin monitoring was 0.23 (95% CI -0.16, 0.62), that is, it did not present statistical significance (p = 0.250). The results of the analysis of heterogeneity within and between the studies indicated high levels of inconsistency (Q = 461.63, p < 0.0001, I2 = 98%), method for Hb values. Conclusions: Although the mean difference between noninvasive measurements of Hb and the gold standard method is small, the co-oximeter can be used as a non-invasive "trend" monitor in detecting unexpected responses at Hb levels.

Resumo Justificativa: A medida da concentração de hemoglobina (Hb)por co-oximetria é uma técnica inovadora que oferece eficiência e agilidade no processamento das informações referentes à medida da concentração de hemoglobina obtida por meio de monitorização contínua, não-invasiva e rápida. Por conta desse atributo, evita exposições desnecessárias do paciente a procedimentos invasivos ao possibilitar redução da quantidade de amostras sanguíneas para avaliação e de outras terapêuticas desnecessárias. Além disso, auxilia a tomada de decisões quanto à necessidade de transfusão e quanto ao manejo da mesma. Objetivo: Comparar o desempenho oferecido para a obtenção dos valores de concentração de hemoglobina entre medida não invasiva da Hb e a ferramenta padrão ouro (exame laboratorial). Conteúdo: O estudo corresponde a uma revisão sistemática seguida de metanálise que incluiu ensaios clínicos devidamente registrados com texto completo, publicados a partir de 1990 até 2018. Foram investigadas as bases de dados PubMed, Cochrane, Medline, Embase e Web Of Science. A diferença média global encontrada entre os métodos não invasivo e invasivo de monitorização da hemoglobina foi de 0,23 (95% IC -0,16; 0,62), ou seja, não apresentou significância estatística (p = 0,250). Os resultados da análise de heterogeneidade dentro e entre os estudos, apontou níveis elevados de inconsistência (Q = 461,63, p< 0,0001, I2 = 98%). Conclusão: Embora a diferença média entre as medidas não invasivas da Hb e o método padrão ouro sejam pequenas, o co-oxímetro pode ser utilizado como um monitor não invasivo de "tendência" na detecção de alterações inesperadas nos níveis de Hb.

[Noninvasive hemoglobin monitoring in clinical trials: a systematic review and meta-analysis]. / Monitorização não invasiva da hemoglobina em ensaios clínicos: uma revisão sistemática e metanálise.

BACKGROUND AND OBJECTIVES: The measurement of Hb by co-oximetry is an innovative technique that offers efficiency and agility in the processing of information regarding the measurement of Hemoglobin concentration (Hb) obtained through continuous, non-invasive and rapid monitoring. Because of this attribute, it avoids unnecessary exposures of the patient to invasive procedures by allowing a reduction in the number of blood samples for evaluation and other unnecessary therapies. It also helps to make decisions about the need for transfusion and how to handle it. The objective of this study is to compare the performance offered to obtain Hb values between the Masimo Corporation (Irvine, CA, USA) instrument and the standard gold tool (laboratory examination). CONTENTS: The study corresponds to a systematic review followed by meta-analysis, which included fully registered full-text clinical trials published from 1990 to 2018. PubMed, Cochrane, Medline, Embase and Web of Science databases were investigated. The mean overall difference found between the non-invasive and invasive methods of hemoglobin monitoring was 0.23 (95% CI -0.16, 0.62), that is, it did not present statistical significance (p = 0.250). The results of the analysis of heterogeneity within and between the studies indicated high levels of inconsistency (Q = 461.63, p < 0.0001, I2 = 98%), method for Hb values. CONCLUSIONS: Although the mean difference between noninvasive measurements of Hb and the gold standard method is small, the co-oximeter can be used as a non-invasive "trend" monitor in detecting unexpected responses at Hb levels.

Frecuencia de ideación suicida en una población de anestesiólogos / Ideation of suicidal in a population of anesthesiologists

INTRODUCTION: Due to the absence of precise data regarding the occupational and mental health of Anesthesiologists (MA), in this study. OBJECTIVES: We sought to identify the frequency of suicidal ideation in Anesthesiologists of a Brazilian state. The goals was to verify the frequency of suicidal ideation and common variables in the Anesthesiologists of the selected population, in order to make a literary contribution and generate knowledge that may be useful, through mental and occupational health strategies. METHOD: An individual, observational, cross-sectional study was conducted, characterized as a research, with a quantitative approach, among anesthesiologists, by means of an electronic questionnaire. RESULTS: 266 questionnaires were applied between September 2018 and November 2018, of which all those who did not answer the questionnaire or did so partially were excluded, as well as those who did not perform the profession in the state of Paraná, resulting in n = 233. DISCUSSION: It was verified that 14.59% (34) of the anesthesiologists in the sample have experienced suicidal thoughts. Suicidal ideation conceptually addresses thoughts, ideas, planning or desire to end life

INTRODUCCIÓN: Debido a la ausencia de datos precisos respecto de la salud laboral y mental de los Médicos Anestesiólogos (MA), en este estudio, se buscó identificar la frecuencia de ideación suicida en anestesiólogos de un Estado brasileño. OBJETIVOS: Verificar la frecuencia de ideación suicida y variables comunes en los anestesiólogos de la población seleccionada, con el fin de realizar una contribución literaria y generar conocimiento que pueda ser útil, por medio de estrategias de salud mental y laboral. MÉTODO: Se realizó un estudio individual, observacional, transversal, caracterizado como investigación, de enfoque cuantitativo, entre médicos anestesiólogos, por medio de un cuestionario electrónico. RESULTADOS: Se aplicaron 266 cuestionarios entre septiembre de 2018 y noviembre de 2018, de los cuales se excluyeron a todos aquellos que no respondieron el cuestionario o lo hicieron de forma parcial, así como aquellos que no desempeñaban la profesión en el Estado de Paraná, dando como resultado n = 233. DISCUSIÓN: Se verificó que el 14,59% (34) de los médicos anestesiólogos de la muestra han experimentado pensamientos suicidas. La ideación suicida conceptualmente aborda pensamientos, ideas, planeación o deseo de terminar con la vida.

Avaliação do grau de satisfação de pacientes atendidos no serviço de medicina de uma clínica escola / Satisfaction degree evaluation among patients helped in the medicine service of a school clinic

Avaliar a satisfação dos pacientes quanto ao atendimento recebido na área da saúde tem sido cada vez mais utilizado como um importante parâmetro definidor da qualidade da atividade prestada. Este trabalho objetiva avaliar o grau de satisfação dos pacientes atendidos no serviço de Medicina de uma clínica escola de Santa Catarina. Realizou-se um estudo observacional, transversal, com coleta de dados primários e abordagem quantitativa. Foram aplicados 349 questionários aos pacientes de todas as especialidades médicas do local, permitindo identificar dados socioeconômicos, grau de satisfação, fatores de insatisfação e principais sugestões para melhoria do local. Encontrou-se maior frequência de pacientes do sexo feminino, média de idade de 49,22 anos, com ensino fundamental incompleto, renda familiar per capita inferior a um salário mínimo e ausência de plano de saúde. Considerando o desfecho satisfação geral, verificou-se 98,3% de satisfação. Um percentual de 53,6% dos entrevistados expressou algum fator de insatisfação, sendo o principal a dificuldade de marcação da primeira consulta (30,5%). A principal sugestão de melhoria indicada pelos pacientes foi, na verdade, a exposição da sua insatisfação, sendo poucas as sugestões dadas por eles que realmente sejam passíveis de aplicação no serviço. Verificou-se alto grau de satisfação com o serviço analisado tanto na avaliação individual do serviço, como na comparação com o setor público e privado. No entanto, recomenda-se estabelecer estratégias que aperfeiçoem o sistema operacional de marcação de consultas, visando manter o nível de satisfação dos usuários.

Evaluating the patients' satisfaction regarding the care received in the health area has been increasingly used as an important parameter defining the quality of activity provided. This study aims to evaluate the satisfaction degree among the patients helped at the school clinic of Santa Catarina. It was a observational, cross-sectional research with primary data collection and quantitative approach. It was interviewed the total of 349 patients from all medical specialties at the site, allowing identification of their socioeconomic data, satisfaction degree, dissatisfaction factors and main suggestions to improvement the site. There was a larger number of female patients, mean age of 49,22 years, with incomplete basic education, the percentage of family income is lower than a minimum wage and no health insurance. Considering the overall satisfaction score, there were 98.3% satisfaction. A percentage of 53.6% of respondents expressed some dissatisfaction, the main complaint was the difficulties about scheduling the first appointment (30.5%). The main suggestion of improvement indicated by the patients was, in fact, the exposure of their dissatisfaction, with few suggestions given by them that really can be applied in the service. There was a high degree of satisfaction with the analyzed servisse both in the individual service evaluation, as in the comparison with the public and private sector. However, it is recommended to establish best practices for the process of marking queries, aiming at maintaining the level of user satisfaction.