Evaluation of anxiety, depression and sleep quality in full-time teleworkers.

BACKGROUND: Mental health-related positive and negative aspects of telework are understudied. This study aimed to evaluate anxiety, depression and sleep quality in full-time teleworkers during lockdown imposed by the coronavirus disease 2019 (COVID-19) pandemic and explore potential relationships between these variables, sociodemographic characteristics, quality of life and perceived productivity. METHODS: A cross-sectional study was conducted on 143 full-time teleworkers. Participants were assessed for anxiety, depression and sleep quality using validated clinical instruments. RESULTS: This study found a high prevalence of poor sleep quality (74%, N = 106). Participants reported anxiety/depressive symptoms with the predominance of anxiety and very high levels of sleep impairment. Better sleep quality was associated with longer sleep duration and better job satisfaction, whereas the use of hypnotic medication and higher depression/anxiety scores seem to point a correlation with sleep impairment. Anxiety/depression positively correlated with worse sleep quality and negatively associated with quality of life. Male sex was negatively associated with perceived productivity. CONCLUSIONS: A higher prevalence of poor sleep quality was found in comparison with other studies performed during the COVID-19 pandemic as well as high levels of anxiety and depression. These results highlight the relevance of considering the potential negative impact of telework on mental health.

Acute non-traumatic tetraparesis - Differential diagnosis.

INTRODUCTION: Potentially life-threatening disorders may present in the emergency department with acute tetraparesis, and their recognition is crucial for an appropriate management and timely treatment. Our review aims to systematize the differential diagnosis of acute non-traumatic tetraparesis. RESULTS: Causes of tetraparesis can be classified based on the site of defect: upper motor neuron (UMN), peripheral nerve, neuromuscular junction or muscle. History of present illness should include the distribution of weakness (symmetric/asymmetric or distal/proximal/diffuse) and associated clinical features (pain, sensory findings, dysautonomia, and cranial nerve abnormalities such as diplopia and dysphagia). Neurological examination, particularly tendon reflexes, helps further in the localization of nerve lesions and distinction between UMN and lower motor neuron. Ancillary studies include blood and cerebral spinal fluid analysis, neuroaxis imaging, electromyography, muscle magnetic resonance and muscle biopsy. CONCLUSIONS: Acute tetraparesis is still a debilitating and potentially serious neurological condition. Despite all the supplementary ancillary tests, the neurological examination is the key to achieve a correct diagnosis. The identification of life-threatening neurologic disorders is pivotal, since failing to identify patients at risk of complications, such as acute respiratory failure, may have catastrophic results.

Risk factors predicting recurrence of transient global amnesia.

OBJECTIVE: To assess risk factors of transient global amnesia (TGA) recurrence. METHODS: Retrospective study of a case series of patients with the diagnosis of TGA in our neurology center in the last 8 years, identified through an anonymized database search. TGA was identified by applying Hodges and Warlow criteria. RESULTS: Seventy patients (70% female, average age 64.8 ± 7.8 years) were enrolled; mean follow-up was 16.5 months. More frequent co-morbidities were hypertension (50%), depression (25.7%), diabetes mellitus (17.1%), migraine (15.7%), and cerebrovascular disease (8.6%). Average TGA episode duration was 4 h. Forty-one percent had an identifiable trigger-emotional stress (25.7%), physical effort (8.6%), and sexual intercourse (4.3%). Five patients (7.1%) had hippocampus restriction on diffusion weighted MRI. Nineteen patients (27.1%) had TGA recurrence. Patients with recurrent TGA were more likely to be female and have history of depression, shorter duration episode, and hippocampus hyperintensity on brain MRI. None of the other clinical characteristics and complementary studies were predictors of recurrence. In the multivariate analysis, history of depression was the only factor found to predict which patients had a higher risk of recurrence. CONCLUSION: We present a cohort of TGA patients with a considerable recurrent rate (27%), alerting for the possibility of recurrence of this clinical entity. TGA recurrence was associated with the following factors: female sex, depression, shorter episode duration, and hippocampal hyperintensity on brain MRI. History of depression was found to be the most important recurrence predictor in our study.

Comparing sleep quality in institutionalized and non-institutionalized elderly individuals.

Objectives: Sleep is a physiological function essential to general health and well-being. Insomnia is a sleep disorder frequently reported by older adults. Institutionalization in nursing care homes may contribute to increase the risk of sleep disorders in this population. The aim of this exploratory study was to compare sleep quality among a group of institutionalized (GI) and a group of non-institutionalized (GNI) elderly individuals.Method: We selected 100 individuals over 65 years of age. Participants were divided into two groups (N = 50 in each group) according to their institutionalization status (GI and GNI). The following assessment instruments were used: Pittsburgh Sleep Quality Inventory (PSQI), Epworth Sonolence Scale (ESS) and Geriatric Depression Scale (GDS). Study groups were compared in their sociodemographic, social and clinical characteristics with statistical analysis performed to detect correlations between variables.Results: GI elderly presented worse overall sleep quality and higher levels of daytime somnolence and depressive symptoms. A positive correlation was found between sleep quality, daytime sleepiness (ESS) (p < 0.01) and depressive symptoms (GDS) (p < 0.01).Conclusions: Our results are consistent with the possibility that elderly individuals admitted to long-term care and residential institutions present with worse sleep quality. Higher levels of depressive symptoms, lower occupational activity and sunlight exposure are specifically associated with a worse sleep quality. Further studies with larger and more diverse samples, including community-dwelling individuals, may be important to consolidate these findings.