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STUDY OBJECTIVES: The COVID-19 pandemic has created unprecedented levels of stress and anxiety, which has a profound effect on sleep quality. However, limited data are available on the sleep quality of medical residents who work directly with patients infected with SARS-CoV-2. As sleep is a crucial brain state, our goal is to know the sleep quality of these medical residents. METHODS: This study evaluated sleep quality among medical residents caring for COVID-19 patients at Hospital São Paulo, SP, Brazil. It used a validated questionnaire and assessed sleep habits and sociodemographic variables. The study focused on sleep latency, bedtime changes, early awakening, and discouragement. RESULTS: 150 resident physicians participated, 93 females and 57 males. We observed poor sleep quality in 72.7%, discouragement complaints in 91.33%, what was moderate or intense in 52.0%. Discouragement was associated with sleep fragmentation and awakening early in the morning; sleeping pill users had a greater sleep latency (p<0.00001). Poor sleep quality was linked to changes in bedtime and use of sleeping medications during social isolation in 2020 (p=0.037 and p<0.001, respectively). CONCLUSIONS: During the COVID-19 pandemic, more than two-thirds of resident physicians experienced poor sleep quality. They changed their bedtime, increased sleep latency, the use of hypnotics, feelings of discouragement, fragmented sleep, and early awakening in the morning. These findings should serve as a wake-up call for everyone, especially those in administrative roles. They are a matter of concern for medical residents, chief residents, supervising physicians, medical directors, and faculties. Maximas gratias vobis agimus.
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AIM: There are no studies comparing tests performed at home with those carried out in the laboratory, using the same device. The only studies that have been performed have compared the device used at home with the standard polygraph used in the laboratory. The purpose of this study was therefore to verify the accuracy of the home diagnosis of obstructive sleep apnea syndrome (OSAS) via unassisted type 2 portable polysomnography, compared with polysomnography using the same equipment in a sleep laboratory. METHODS: To avoid any possible order effect on the apnea-hypopnea index (AHI), we randomly created two groups of 20-total 40 patients, according to the test sequence. One of the groups had the first test at home and the second test in the laboratory (H-L); the other group had the first test in the laboratory and the second at home (L-H). The second test always took place on the night immediately following the first test. All polysomnographic monitoring was undertaken with the same equipment, an Embletta X100 system (Embla, Natus Inc., Middleton, USA). The Embletta X100 is a portable polygraph that records eleven polygraph signs: (1) electroencephalogram C4/A; (2) electroencephalogram O2/M1; (3) submental EMG; (4) electrooculogram of the right side; (5) nasal cannula (air flow); (6) respiratory effort against a plethysmographic chest strap; (7) respiratory effort against an abdominal plethysmographic belt; (8) heart rate; (9) saturation of oxyhemoglobin; (10) snoring; and (11) body position. RESULTS: There was no difference in sleep efficiency between the group monitored in the laboratory and the group tested at home (p = 0.30). There was no difference in total sleep time (p = 0.11) or sleep latency (p = 0.52), or in the latency in phases N2 and N3 between the monitoring in the laboratory and at home (N2 p = 0.24; N3 p = 0.09). Some differences occurred regarding the PSG that took place at home, with longer duration of wake after sleep onset (WASO) and longer latency for REM sleep, due to failure of the patient to start the monitoring by pressing the "events" button on the device. In the distribution of sleep phases, there was no difference between the group monitored in the laboratory and the group tested at home. CONCLUSION: Results from home sleep monitoring correlate well with the laboratory "gold standard" and may be an option for diagnosing OSAS in selected patients.
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Equipamentos para Diagnóstico/normas , Monitorização Ambulatorial/instrumentação , Polissonografia/instrumentação , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: We describe a case of sleep state misperception in a patient with a neurotoxoplasmosis lesion in the left nucleocapsular region. CASE REPORT: A 40-year-old female patient presented relating sleeplessness over the past 2 years, concurrent with progressive headaches, dizziness and motor and sensory deficits in the right upper and lower limbs. She had a history of AIDS, on irregular antiretroviral therapy and neurotoxoplasmosis. A polysomnography confirmed the hypothesis of sleep state misperception, and magnetic resonance imaging revealed a residual lesion in the left nucleocapsular region. CONCLUSION: Different models consider that the sleep state misperception could be correlated to structural abnormalities of the central nervous system. A recent study showed that the medial prefrontal cortex had a lower activation in patients with unrefreshing sleep due to chronic fatigue syndrome. This case report highlights the possibility of sleep state misperception having - at least partially - an anatomical substrate in the left nucleocapsular region.
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BACKGROUND: Restless Legs Syndrome, a potentially disabling sleep disorder, also known as Willis-Ekbom disease (RLS/WED), may be caused by loss of inhibitory modulation of descending central motor pathways, structural changes in the somatosensory cortex, abnormal connectivity between motor and sensory areas, as well as by subtle abnormalities in white matter micro-organization. OBJECTIVE: To compare diffusion-tensor imaging (DTI) metrics in areas associated with sensory or motor function, as well as sensorimotor integration, between subjects with primary mild-to-severe RLS/WED and controls. METHODS: DTI metrics were assessed in 38 subjects with RLS/WED (14 mild to moderate, 24 severe to very severe) and 24 healthy age-matched controls with whole-brain Tract Based Spatial Statistics (TBSS), Region-of-interest (ROI) and probabilistic tractography based analyses. The ROIs corresponded to the corticospinal tract (CST) at the level of the cerebral peduncle; the superior, middle and inferior cerebellar peduncles. Subgroup analyses were made according to the severity of RLS/WED symptoms. The corticospinal tract was evaluated with probabilistic tractography. We also explored associations between significant findings and severity of symptoms with the Spearman's correlation coefficient. RESULTS: TBSS analysis revealed decreased axial diffusivity (AD) in the left posterior thalamic radiation in RLS/WED. In subjects with severe RLS/WED, AD was reduced in the left posterior corona radiata and this reduction was negatively correlated with severity of symptoms. ROI-based analysis showed that radial diffusivity (RD) was increased in the superior cerebellar peduncles of individuals with severe RLS/WED. Tractography did not show between-group or subgroup differences. CONCLUSIONS: Our results are consistent with subtle white matter changes, prominently in RLS/WED subjects with more severe symptoms, in areas related to sensory or motor function, as well as to sensorimotor integration, compared to controls. These findings support the hypothesis, raised by prior pathophysiological studies, of defective integration within these networks.
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Síndrome das Pernas Inquietas , Substância Branca , Encéfalo/diagnóstico por imagem , Imagem de Tensor de Difusão , Humanos , Síndrome das Pernas Inquietas/diagnóstico por imagem , Índice de Gravidade de Doença , Substância Branca/diagnóstico por imagemRESUMO
OBJECTIVE/BACKGROUND: Machado-Joseph disease (MJD) or spinocerebellar ataxia type 3 (SCA3) is the most common type of autosomal dominant spinocerebellar ataxia (SCA). Sleep disorders have been described as frequent non-motor symptoms in MJD, and with marked impairment on quality of life. However, few studies have evaluated the frequency and characteristics of sleep apnea in MJD. PATIENTS/METHODS: This study analyzed the prevalence of sleep apnea in 47 patients with MJD by using polysomnography. Clinical variables such as age, age at onset of symptoms, duration of symptoms (at time of evaluation), body index mass, ataxia scales severity and CAG repeat length were compared with polysomnographic findings. RESULTS: Thirty four percent of MJD patients had OSAS, and 42.5% had excessive daytime somnolence. There were no differences considering ataxia severity, CAG repetition length or other clinical variable. CONCLUSIONS: Patients with MJD have high frequency of obstructive sleep apnea, and this sleep disorder is not correlated with ataxia severity, CAG repetition length or other clinical variable.
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Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Doença de Machado-Joseph/complicações , Polissonografia/métodos , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Brasil/epidemiologia , Feminino , Humanos , Masculino , Qualidade de VidaRESUMO
OBJECTIVE: To compare the duration of the cortical silent period (CSP) measured in a hand muscle in subjects with primary Restless Legs Syndrome (RLS/WED) and controls, using four different methods of analysis. METHODS: The CSP to transcranial magnetic stimulation of the dominant motor cortex was assessed in the abductor digiti minimi of 33 subjects with RLS/WED and 24 controls. CSP duration was measured by an automated and three visually-guided methods. RESULTS: There were significant differences between absolute values of CSP duration according to the method of analysis. However, irrespectively of the method used for CSP assessment, no differences were found between measurements performed in subjects with RLS/WED and subjects from the control group. CONCLUSIONS: Absolute values of CSP durations analyzed by different methods should not be directly compared, because significantly different results can be obtained from the same data set. SIGNIFICANCE: The CSP assessed from a hand muscle is unlikely to be a biomarker of primary RLS/WED. Our results highlight the importance of standardizing the definition of CSP onset and offset, as well as of describing in detail the methodology chosen to record and measure CSP duration, in order to enable comparisons between studies.
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Potencial Evocado Motor/fisiologia , Córtex Motor/fisiopatologia , Contração Muscular/fisiologia , Síndrome das Pernas Inquietas/patologia , Estimulação Magnética Transcraniana , Adolescente , Adulto , Idoso , Análise de Variância , Estudos de Casos e Controles , Eletromiografia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
STUDY OBJECTIVES: To report two female patients with paraneoplastic cerebellar degeneration (PCD) related to breast cancer that presented with rapid eye movement-sleep behavior disorder (RBD) and improved sleep symptoms with immunotherapy. METHODS: The two patients were evaluated through clinical scale and polysomnography before and after therapy with intravenous immunoglobulin. RESULTS: RBD was successfully treated with immunotherapy in both patients. Score on the RBD screening questionnaire dropped from 10 to 1 or 0, allied with the normalization of polysomnographic findings. CONCLUSIONS: A marked improvement in RBD after immunotherapy in PCD raises the hypothesis that secondary RBD may be an immune-mediated sleep disorder.
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Imunoterapia , Degeneração Paraneoplásica Cerebelar/complicações , Degeneração Paraneoplásica Cerebelar/terapia , Transtorno do Comportamento do Sono REM/complicações , Transtorno do Comportamento do Sono REM/terapia , Adulto , Idoso , Neoplasias da Mama/complicações , Feminino , Humanos , Degeneração Paraneoplásica Cerebelar/imunologia , Polissonografia , Transtorno do Comportamento do Sono REM/imunologia , SonoRESUMO
Spinocerebellar ataxias (SCA) are autosomal dominant neurodegenerative disorders that affect the cerebellum and its connections, and have a marked clinical and genetic variability. Machado-Joseph disease (MJD) or spinocerebellar ataxia type 3 (SCA3)--MJD/SCA3--is the most common SCA worldwide. MJD/SCA3 is characterized classically by progressive ataxia and variable other motor and non-motor symptoms. Sleep disorders are common, and include rapid eye movement (REM) sleep behaviour disorder (RBD), restless legs syndrome (RLS), insomnia, excessive daytime sleepiness, excessive fragmentary myoclonus and sleep apnea. This study aims to focus upon determining the presence or not of non-REM (NREM)-related parasomnias in MJD/SCA 3, using data from polysomnography (PSG) and clinical evaluation. Forty-seven patients with clinical and genetic diagnosis of MJD/SCA3 and 47 control subjects were evaluated clinically and by polysomnography. MJD/SCA3 patients had a higher frequency of arousals from slow wave sleep (P < 0.001), parasomnia complaints (confusional arousal/sleep terrors, P = 0.001; RBD, P < 0.001; and nightmares, P < 0.001), REM sleep without atonia (P < 0.001), periodic limb movements of sleep index (PLMSi) (P < 0.001), percentage of N3 sleep (P < 0.001) and percentage of N1 sleep (P < 0.001). These data show that NREM-related parasomnias must be included in the spectrum of sleep disorders in MJD/SCA3 patients.
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Doença de Machado-Joseph/complicações , Doença de Machado-Joseph/fisiopatologia , Parassonias/complicações , Parassonias/fisiopatologia , Adulto , Nível de Alerta/fisiologia , Estudos de Casos e Controles , Sonhos , Feminino , Humanos , Doença de Machado-Joseph/genética , Masculino , Pessoa de Meia-Idade , Terrores Noturnos/complicações , Polissonografia , Síndrome das Pernas Inquietas/complicações , Síndrome das Pernas Inquietas/fisiopatologia , Sono/fisiologiaRESUMO
There is no consensus about mechanisms underlying restless legs syndrome (RLS), also known as Willis-Ekbom disease (WED). Cortical excitability may be abnormal in RLS. Transcranial magnetic stimulation (TMS) can provide insight about cortical excitability. We reviewed studies about measures of excitability to TMS in RLS. Original studies published between January 1999 and January 2015 were searched in PubMed, Scopus, and Web of Science databases. Inclusion criteria were as follows: original studies involving primary RLS in patients from both sexes and ages between 18 and 85 years; TMS protocols clearly described; and they were written in English, in peer-reviewed journals. Fifteen manuscripts were identified. TMS protocols were heterogeneous across studies. Resting motor threshold, active motor threshold, and amplitudes of motor-evoked potentials were typically reported to be normal in RLS. A reduction in short-interval intracortical inhibition (SICI) was the most consistent finding, whereas conflicting results were described in regard to short-interval intracortical facilitation and the contralateral silent period. Decreased SICI can be reversed by treatment with dopaminergic agonists. Plasticity in the motor cortex and sensorimotor integration may be disrupted. TMS may become a useful biomarker of responsiveness to drug treatment in RLS. The field can benefit from increases in homogeneity and sizes of samples, as well as from decrease in methodological variability across studies.
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Córtex Motor/fisiopatologia , Síndrome das Pernas Inquietas/fisiopatologia , Estimulação Magnética Transcraniana , Humanos , Estimulação Magnética Transcraniana/métodosRESUMO
OBJECTIVE: The aim of the present study was to validate The Tucson Children's Assessment of Sleep Apnea Study (TuCASA) questionnaire for use in the Brazilian population. METHODS: Of the total 62 children who participated in the present study (27 girls), aged 4 to 11 years, 45 (72.6%) had sleep-disordered breathing (SDB) diagnosed by polysomnography, while 17 (27.4%) had no sleep disorders. Translation, back-translation, and pretesting were previously performed. The final Portuguese-language version of TuCASA was administered to the participants from May 2012 to August 2013. The interviewer was blinded to presence or absence of SDB. Cronbach's alpha for the overall scale (with 95% CI) and the effect of excluding any items were evaluated. RESULTS: There was no difference among TuCASA items/score and the presence of SDB with either age or gender. The TuCASA had a Cronbach's alpha coefficient of 0.726 (95% CI 0.614 to 0.817), which denotes satisfactory internal consistency - a finding reinforced by evaluation of the effect of item exclusion on the questionnaire. Convergent validity was also satisfactory, in as much as most correlations were positive and significant. CONCLUSION: The translated version of the TuCASA questionnaire was validated for Brazilian populations and proved to be a reliable, validated instrument that can be used in clinical practice for evaluation of children with symptoms of SDB.
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Apneia Obstrutiva do Sono/diagnóstico , Brasil , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Polissonografia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To evaluate the effectiveness of electrical stimulation of the posterior tibialis nerve in men with neurogenic overactive bladder secondary to ischemic stroke at 45 days and 12 months after treatment. MATERIALS AND METHODS: We studied 24 patients older than 18 years, with ischemic stroke that occurred between 6 months and 3 years previously and with no prior urinary symptoms. These patients were randomly allocated to receive electrical stimulation of the posterior tibialis nerve twice weekly for 6 weeks (treatment group, n = 12) or general advice and stretching sessions 1 to 3 times monthly for 6 weeks (control group, n = 12). Each session lasted 30 minutes in both groups. The primary outcomes were reduction in urinary frequency, reduction in urinary urgency, and overall improvement in voiding diary variables. RESULTS: Patients in the electrical stimulation group, in relation to baseline and to control group, experienced improvement in urinary symptoms, reducing urinary urgency and frequency, and reported subjective improvement after treatment. This effect persisted after 12 months of follow-up. The patients with lesion in right hemisphere, advanced age, and with higher body mass index presented more chance to develop urinary symptoms. CONCLUSION: Electrical stimulation of the posterior tibialis nerve is a safe and effective option for the treatment of poststroke neurogenic overactive bladder in men, reducing urinary frequency and urgency.
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Nervo Tibial/patologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Bexiga Urinária Hiperativa/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enurese Noturna , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , MicçãoRESUMO
BACKGROUND: Parents of children with migraine have described a higher prevalence of sleep bruxism and other sleep disturbances in their children. The objective of this study was to use polysomnography to investigate the prevalence of bruxism during sleep in children with episodic migraine relative to controls. FINDINGS: Controls and patients were matched by sex, age, years of formal education, presence of snoring, arousals per hour, and respiratory events per hour.A total of 20 controls, between 6 and 12 years old, with no history of headache, recruited from public schools in Sao Paulo between 2009 and 2012, and 20 patients with episodic migraine recruited from the Headache Clinic at the Federal University of Sao Paulo between 2009 and 2012 underwent polysomnography.No intervention was performed before sleep studies.Among migraine patients, 27.5% experienced aura prior to migraine onset. The sleep efficiency, sleep latency, REM sleep latency, arousals per hour, percentage of sleep stages, and breathing events per hour were similar between groups. Five children (25%) with episodic migraine exhibited bruxism during the sleep study while this finding was not observed in any control (p = 0.045). CONCLUSIONS: Our data demonstrate that bruxism during sleep is more prevalent in children with episodic migraine. Further prospective studies will help elucidate the underlying shared pathogenesis between bruxism and episodic migraine in children.
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Bruxismo/complicações , Bruxismo/epidemiologia , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/epidemiologia , Polissonografia , Brasil/epidemiologia , Bruxismo/fisiopatologia , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Transtornos de Enxaqueca/fisiopatologia , Prevalência , SonoRESUMO
Spinocerebellar ataxia type 3 or Machado-Joseph disease is the most common spinocerebellar ataxia. In this neurological disease, anatomical, physiological, clinical, and functional neuroimaging demonstrate a degenerative process besides the cerebellum. We performed neurophysiological and neuroimaging studies-polysomnography, transcranial sonography, vestibular-evoked myogenic potential, single-photon emission computed tomography (SPECT) with (99m)Tc-TRODAT-1, and a formal neuropsychological evaluation in a patient with sleep complaints and positive testing for Machado-Joseph disease, without cerebellar atrophy, ataxia, or cognitive complaints. Polysomnography disclosed paradoxical high amplitude of submental muscle, characterizing REM sleep without atonia phenomenon. Transcranial sonography showed hyperechogenicity of the substantia nigra. There was an absence of vestibular-evoked myogenic potentials on both sides in the patient under study, in opposite to 20 healthy subjects. Brain imaging SPECT with (99m)Tc-TRODAT-1 demonstrated a significant lower DAT density than the average observed in six healthy controls. Electroneuromyography was normal. Neuropsychological evaluation demonstrated visuospatial and memory deficits. Impairment of midbrain cholinergic and pontine noradrenergic systems, dysfunction of the pre-synaptic nigrostriatal system, changes in echogenicity of the substantia nigra, and damage to vestibulo-cervical pathways are supposed to occur previous to cerebellar involvement in Machado-Joseph disease.
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Encéfalo/patologia , Encéfalo/fisiopatologia , Doença de Machado-Joseph/complicações , Doença de Machado-Joseph/patologia , Neurofisiologia , Transtornos do Sono-Vigília/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Eletroencefalografia , Humanos , Masculino , Compostos de Organotecnécio , Polissonografia , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos , Ultrassonografia Doppler Transcraniana , Potenciais Evocados Miogênicos VestibularesRESUMO
OBJECTIVE: Machado-Joseph disease (MJD) is a neurodegenerative disease which usually presents several clinical findings including cerebellar ataxia and other extracerebellar features, such as Parkinsonism, dystonia, peripheral neuropathy, and lower motor neuron disease. Some data have demonstrated a high frequency of sleep disorders in these patients, including excessive daytime sleepiness (EDS), insomnia, obstructive sleep apnea (OSA), rapid eye movement (REM) sleep behavior disorder (RBD), and restless legs syndrome (RLS). Herein, we aimed to describe the high frequency of excessive fragmentary myoclonus (EFM) in MJD. MATERIALS AND METHODS: We recruited 44 patients with MJD and 44 healthy controls. All participants underwent an all-night polysomnography (PSG). EFM was evaluated and defined in accordance to the criteria of the American Academy of Sleep Medicine. RESULTS: Half of the MJD patients (n = 22) had EFM diagnosed through PSG, though no healthy control participant presented this finding (P < .0001). In the MJD group, older participants and men had a higher frequency of EFM. There was no correlation between EFM and the following data: body mass index (BMI), apnea-hypopnea index (AHI), EDS, loss of atonia during REM sleep, periodic limb movements during sleep (PLMS), RLS, RBD, ataxia severity, the number of cytosine-adenine-guanine trinucleotide (CAG) repeats, disease duration, sleep efficiency, sleep fragmentation, and sleep stage percentages between patients with or without EFM. CONCLUSION: EFM is highly prevalent in patients with MJD. Our study demonstrates that EFM must be included in the clinical spectrum of sleep disorders in MJD patients.
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Doença de Machado-Joseph/complicações , Síndrome da Mioclonia Noturna/etiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome da Mioclonia Noturna/fisiopatologia , Polissonografia , Fatores de Risco , Sono/fisiologiaRESUMO
OBJECTIVE: We aimed to compare the academic performance of children with and without symptoms of sleep disorders (SSD). METHODS: We distributed 5400 questionnaires (Sleep Disturbance Scale for Children [SDSC], Brazilian version) to 7- to 10-year-old children at public elementary schools in São Paulo, Brazil. We analyzed the academic grades of Portuguese (Port) and Mathematics (Math) in 2384 children (1224 girls; 51%). Grades were assigned on a scale of 0-10 and five was considered a passing grade. Children with symptoms of sleep disorders (SSD) and symptoms of sleep-breathing disorders (SSBD) were compared to children with no symptoms of SSD (no-SSD). RESULTS: Mean Port (6.6±2.2) and Math (6.3±2.2) grades were lower in children with SSD or sleep-breathing disorders (SBD) than those among children with no-SSD (Port, 7.1±2.1 and Math, 7.1±2.1; P<.05). Boys with SSD or SSBD had lower grades (Port, 6.4±2.2 and Math, 6.1±2.2) than girls (Port, 6.9±2.2 and Math, 6.5±2.2; P<.05). There were more children with failing Port grades with SSD or SSBD (13%) than those among children with no-SSD (9%; P<.05). Regarding Math, 25.4% of SSD or SSBD children had failing grades vs. 8.4% of children with no-SSD (P<.05). CONCLUSION: In our sample, children with SSD particularly SBD were at increased risk for poor academic performance in Math and Port.
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Avaliação Educacional , Deficiências da Aprendizagem/etiologia , Síndromes da Apneia do Sono/complicações , Transtornos do Sono-Vigília/complicações , Brasil , Criança , Cognição , Feminino , Humanos , Deficiências da Aprendizagem/diagnóstico , Linguística/educação , Masculino , Matemática/educação , Síndromes da Apneia do Sono/diagnóstico , Transtornos do Sono-Vigília/diagnóstico , Estatísticas não Paramétricas , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The use of unstructured play as an intervention to help children cope with the stress of a hospitalization period was tested in this randomized clinical trial. METHODS: Urinary cortisol (a stress marker) was examined in 53 pediatric patients hospitalized for respiratory diseases in a public hospital, divided into two groups that did or did not play. RESULTS: Boys and girls from the play group, 7-11 years old, showed a decrease in cortisol levels after participating in play activities. In younger participants (4-7 years old) the intervention did not seem as efficient, probably because in this group maturity levels may have influenced how children cognitively engaged in play as a coping strategy. CONCLUSIONS: The study showed the importance of using interventions that consider age ranges and gender in enhancing coping strategies, as well as the importance of such techniques that are employed by occupational therapists since they are professionals with expertise in the use of activities as therapeutic instruments.
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Criança Hospitalizada/psicologia , Hidrocortisona/urina , Terapia Ocupacional/métodos , Jogos e Brinquedos , Estresse Psicológico/reabilitação , Adaptação Psicológica , Adolescente , Fatores Etários , Biomarcadores/urina , Criança , Pré-Escolar , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores Sexuais , Estresse Psicológico/diagnóstico , Estresse Psicológico/urina , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To investigate occurrences of swallowing disorders after ischemic stroke. METHOD: This was a retrospective study on 596 medical files. The inclusion criterion was that the patients needed to have been hospitalized with a diagnosis of ischemic stroke; the exclusion criteria were the presence of associated cardiac problems and hospital stay already more than 14 days. RESULTS: 50.5% were men and 49.5% women; mean age 65.3 years (SD= ± 11.7) (p ≤ 0.001). Among the risk factors, 79.4% had hypertension, 36.7% had diabetes (p ≤ 0.001) and 42.7% were smokers. 13.3% of the patients died. Swallowing disorders occurred in 19.6%, among whom 91.5% had mild difficulty and 8.5% had severe difficulty. 87.1% had spontaneous recovery after a mean of 2.4 months. A lesion in the brainstem region occurred in 6.8% (p ≤ 0.001). CONCLUSION: Swallowing disorders occurred in almost 20% of the population and most of the difficulty in swallowing found was mild. The predictors for swallowing disorders were older age, diabetes mellitus and lesions in the brainstem region.