Post-traumatic stress disorder prevalence and sleep quality in fire victims and rescue workers in southern Brazil: a cross-sectional study.

OBJECTIVES: This survey was conducted to evaluate the prevalence of post-traumatic stress disorder (PTSD) and the sleep quality in victims and rescue team of the third deadliest nightclub fire in the world. STUDY DESIGN: A cross-sectional study. METHODS: Participants were victims and rescue workers exposed to a fire at a nightclub, which occurred in January 2013 in Southern Brazil. The Pittsburgh Sleep Quality Index (PSQI), composed of seven subjective sleep variables (including daytime dysfunction), and PTSD Checklist - Civilian version (PCL-C) were applied to all people who sought medical attention at the local reference center in the first year after the event. Comprehensive information was obtained concerning sociodemographic factors, health status, and sleep complaints. RESULTS: A total of 370 individuals, 190 victims and 180 rescue workers, were included. Participants were 70% male, with an average age of 29 years. The prevalence of PTSD was 31.9%, ranging from 24.4% for rescue workers to 38.9% for victims. The prevalence of poor sleep quality was 65.9%, ranging from 56.1% for rescue workers to 75.3% for victims. Most of the participants with PTSD (91.5%) had PSQI scores >5 (poor sleepers), against 54.0% of the non-PTSD individuals. All seven PSQI subscores showed significant differences between PTSD and non-PTSD individuals, especially daytime dysfunction. Sex, shift work, previous psychiatric disease, and sleep quality remained associated with PTSD in adjusted models, with a prevalence ratio (95% CI) of 1.76 (1.28-2.43) in females, 1.73 (1.17-2.55) in shift workers, 1.36 (1.03-1.80) in individuals with psychiatric disease history, and 5.42 (2.55-11.52) in poor sleepers. CONCLUSIONS: The presence of daytime dysfunction increased by at least tenfold the prevalence of PTSD in this sample. Considering that daytime dysfunction was shown to be strongly associated with PTSD, sleep-related issues should be addressed in the assessment of individuals exposed to traumatic events, both victims and rescuers. Factors like shift work and female sex were also associated with PTSD, especially among victims.

Metabolic disturbances due to a high-fat diet in a non-insulin-resistant animal model.

OBJECTIVE: Shift workers have metabolic changes more often than day workers. It is also known that night workers prefer foods high in saturated fat. Such data suggest that shift workers are prone to cardiovascular disease. Therefore, the objective of this study was to propose an animal model to test the effect of high-fat diet (HFD) based on shift workers' diet. METHODS: This is an experimental study with 20 Wistar rats. Ten rats were allocated to the control group (CG) and were fed standard diet. Ten rats were allocated to the experimental group (EG) and were fed HFD (45% fat). Serum triglycerides (TG), glucose and high-density lipoprotein-cholesterol (HDL-cho) were measured 5, 10 and 15 weeks after the beginning of the study. The amount of visceral adipose tissue (VAT) was determined. Body weight was assessed weekly, and food and water intake were measured daily. Student's t-test was used for independent samples, and P<0.05 was considered significant. RESULTS: After 15 weeks of intervention, the EG showed increased serum levels of TG (P=0.001) and glucose (P<0.001) and decreased HDL-cho (P<0.001) when compared with the CG. The EG showed increased VAT (P=0.005) and liver weight (P=0.01). Food intake and water intake were higher in the CG (P<0.001 and P<0.001, respectively), whereas energy intake showed no difference (P=0.48). No difference was found in the weight of adrenal glands (P=0.07) and body weight (P=0.63). CONCLUSIONS: The experimental diet was effective to show changes in the serum levels of glucose, TG and HDL-cho and visceral fat in spite of no change in body weight in 15 weeks.

Incisional hernia in patients at risk: can it be prevented?

INTRODUCTION: Incisional hernia is a long-term complication of laparotomy. Its exact frequency varies according to different authors, but is always around 10-15%. There are patients who present with systemic associated diseases [chronic obstructive pulmonary disease (COPD), obesity, severe cardiopathies, immunodeficiencies, etc.] that favour or increase the risk of appearance of an incisional hernia. The aim of the present study was to assess whether the prophylactic placement of a polypropylene mesh in patients at risk can reduce or avoid the appearance of an incisional hernia. MATERIALS AND METHODS: Seventy-two selected patients with clear risk factors and colon pathology underwent surgical intervention through median infraumbilical laparotomy. During laparotomy the preperitoneal space was dissected at a point where a low-molecular weight polypropylene mesh was to be placed when closing the peritoneum. Meshes were about 7-8 cm wide and had a variable length that depended on the length of the surgical incision. Of the 72 patients, 41 were obese (BMI > 30 kg/m(2)), 45 presented with COPD, and 42 with colorectal neoplasia; 29 patients had two risk factors, and 15 had three risk factors. The mesh was held in place with polypropylene stitches in 28% of cases, and with fibrin glue in 72% of cases. RESULTS: All patients were assessed by a protocol that included interview, examination of the surgical wound, and abdominal CT scan. Follow-up was between 3 and 5 years. There were no noteworthy complications or operative mortality. No mesh had to be removed in any patient. Two patients developed liver metastasis, and in a second surgery the good condition of the abdominal wall and the absence of hernia were confirmed. Twenty patients required postoperative chemotherapy. Two patients died at 37 and 43 months after surgery because of progression of the neoplastic disease. Fourteen patients were monitored for more than 5 years after surgery, and 46 patients were monitored for 48 months. None of the 72 patients developed an incisional hernia. CONCLUSION: Prophylactic use of a low-molecular-weight polypropylene mesh in abdominal surgery may be useful for the prevention of incisional hernia.

Obesity and shift work: chronobiological aspects.

The present review has the objective of summarising chronobiological aspects of shift work and obesity. There was a systematic search in PubMed databases, using the following descriptors: shift work; obesity; biological clock. Shift work is extremely frequent in several services and industries, in order to systematise the needs for flexibility of the workforce, necessary to optimise productivity and business competitiveness. In developing countries, this population represents a considerable contingent workforce. Recently, studies showed that overweight and obesity are more prevalent in shift workers than day workers. In addition, the literature shows that shift workers seem to gain weight more often than those workers submitted to a usual work day. In conclusion, there is considerable epidemiological evidence that shift work is associated with increased risk for obesity, diabetes and CVD, perhaps as a result of physiological maladaptation to chronically sleeping and eating at abnormal circadian times. The impact of shift work on metabolism supports a possible pathway to the development of obesity and its co-morbities. The present review demonstrated the adverse cardiometabolic implications of circadian misalignment, as occurs chronically with shift workers.

[Splanchnic remodeling secondary to experimental prehepatic portal hypertension]. / Remodelación esplácnica secundaria a hipertensión portal prehepática experimental.

OBJECTIVE: Portal hypertension as an inducer of intestinal inflammatory response would cause epithelial and splanchnic vascular remodeling in the long-term. This experimental study was carried out to verify this hypothesis. METHOD: Structural alterations characteristic of intestinal epithelial and mesenteric vascular remodeling, the density of goblet cells and the diameter of mesenteric vein branches were studied, respectively, in rats with partial portal vein ligation in the short (1 month) and long-term (1 year). RESULTS: Hyperplasia of goblet cells in the small intestine (duodenum, jejunum, ileum) is maximum after 1 year of evolution of the portal hypertension and is associated with dilatation of the distal branches (3rd and 4th order) of the superior mesenteric vein. CONCLUSION: Long-term splanchnic remodeling in experimental portal hypertension suggests the existence of a chronic inflammatory process in this clinical condition.

[Development of pre-hepatic portal hypertension of the rat]. / Tipos evolutivos de hipertensión portal prehepática en la rata.

OBJECTIVE: A long-term study of the prehepatic portal hypertension model by triple stenosing ligation of the portal vein in the rat. METHOD: A cluster analysis of the animals in the different evolutive stages of portal hypertension (1 1/2, 6, 12 and 14 months) has been carried out. This analysis has made it possible to identify three homogeneous groups (A, B and C) in relationship to the liver weight. RESULTS: The animals with liver atrophy (group C) show a decrease of body, splenic and testicular weights as well as a higher development of the portosystemic collateral circulation in relation to the A and B groups. CONCLUSION: The percentage of animals belonging to the group C decrease progressively during the evolution of portal hypertension and those animals corresponding to the group A, in which is superior the liver weight, increase, while the B group does not change.

Effect of pre-operative anxiolysis on postoperative pain response in patients undergoing total abdominal hysterectomy.

In a double blind, placebo-controlled trial, we have assessed the effects of pre-operative anxiolysis on postoperative pain scores in 112 ASA I-II women, aged 18-65 years, scheduled to undergo total abdominal hysterectomy. Subjects were randomly allocated to receive either oral diazepam 10 mg (n=56) or placebo (n=56) pre-operatively. Postoperative anxiety, pain scores, analgesic consumption, and sedation were evaluated at several time points during the first 24 h following surgery. Postoperative pain scores were found to be significantly higher in the diazepam group. Trait and state anxiety showed a significant effect on pain scores, independent of the treatment group. No difference was found between the groups in morphine consumption, but there was a significant reduction in morphine consumption with time.

Sleep disturbances associated with minor psychiatric disorders in medical students.

We performed a cross-sectional study with 342 medical students (age range, 18-35 years) to identify, among a group of sleep disturbances, those which are related to minor psychiatric disorders in this population. The instruments employed for data collection were the self-reporting questionnaire (SRQ-20), the morningness/eveningness questionnaire, the Epworth sleepiness scale, and a general questionnaire regarding demographic characteristics, use of drugs, history of psychopathology, usual fall-asleep time, usual wake-up time, amount of sleep, arousal during the night, and insomnia. We used a logistic regression model to determine independent factors associated with minor psychiatry disorders. Daytime sleepiness [odds ratio (OR), 2.12; 95% CI, 1.21-3.71], arousal [OR, 4.54; 95% CI, 1.97-10.47], insomnia [OR 2.45; 95% CI, 1.32-4.56], and sleeping less than 7 hours per night [OR, 2.02; 95% CI, 1.11-3.67] were associated with minor psychiatric disorders. This group of variables determined a cumulative risk ratio of 5.47 [95% CI, 2.87-10.41] for the main outcome.

Evaluation of behavioral states among morning and evening active healthy individuals.

The Horne-Ostberg questionnaire partly covers some factors that may be important determinants of peak time and characterize patterns of behavior. We conducted a study for the evaluation of self-reported behavioral states (hunger sensation, availability for study, physical exercise, solving daily problems, and time preferences) as expressions of underlying cyclic activity. Three hundred and eighteen community subjects without history of medical, psychiatric, or sleep disorders were evaluated in a cross-sectional design. A self-report about daily highest level of activity was used to categorize individuals into morning, evening, and indifferently active. Time-related behavioral states were evaluated with 23 visual analog questions. The responses to most analogic questions were significantly different between morning and evening active subjects. Logistic regression analysis identified a group of behaviors more strongly associated with the self-reported activity pattern (common wake up time, highest subjective fatigue, as well as wake up, bedtime, exercise and study preferences). These findings suggested that the patterns of activity presented by normal adults were related to specific common behavioral characteristics that may contribute to peak time.

Evaluation of behavioral states among morning and evening active healthy individuals

The Horne-Östberg questionnaire partly covers some factors that may be important determinants of peak time and characterize patterns of behavior. We conducted a study for the evaluation of self-reported behavioral states (hunger sensation, availability for study, physical exercise, solving daily problems, and time preferences) as expressions of underlying cyclic activity. Three hundred and eighteen community subjects without history of medical, psychiatric, or sleep disorders were evaluated in a cross-sectional design. A self-report about daily highest level of activity was used to categorize individuals into morning, evening, and indifferently active. Time-related behavioral states were evaluated with 23 visual analog questions. The responses to most analogic questions were significantly different between morning and evening active subjects. Logistic regression analysis identified a group of behaviors more strongly associated with the self-reported activity pattern (common wake up time, highest subjective fatigue, as well as wake up, bedtime, exercise and study preferences). These findings suggested that the patterns of activity presented by normal adults were related to specific common behavioral characteristics that may contribute to peak time

[Diagnostic reliability in mental disorders of the International Classification of Diseases in primary care]. / Confiabilidade diagnóstica dos transtornos mentais da versão para cuidados primários da Classificação Internacional das Doenças.

INTRODUCTION: The objective is to evaluate the test version of Chapter V - "Mental and Behavioral Disorders reliability", of the 10th revision of the International Classification of Diseases, Version for Primary Care (ICD -10 PC), prepared by the Division of Mental Health of the World Health Organization (WHO). METHODS: During September and October of 1994, Community General Physicians (CGP) from the Health and Environment Department of the State of Rio Grande do Sul were trained in the use of this version, prepared for the field trial, according to the design proposed by WHO. RESULTS: The results refer to a study about reliability of diagnosis attributed by 9 pairs of CGP to 460 patients in their first appointments. Cohen's Kappa for Mental Health Disorder, present or absent, was 0,79 (CI 95%: 0,69 - 0,88). CONCLUSION: The use of ICD-10 CP will give more specificity to the information and will allow a better communication between health workers at the level of primary care