Mental health outcomes in frontline healthcare workers in Brazil during the COVID-19 epidemic: Results of an online survey in four regions using respondent-driven sampling (RDS).

BACKGROUND: The COVID-19 pandemic overwhelmed health facilities and presented healthcare workers (HCWs) with a new infectious disease threat. In addition to a sanitary crisis, Brazil still had to face major political, economic, and social challenges. This study aimed to investigate mental health outcomes in frontline HCWs in different regions of the country and at different epidemic times. We also sought to identify the main risk factors associated with these outcomes. METHODS: A cross-sectional online survey using respondent-driven sampling was conducted to recruit physicians (n = 584), nurses (n = 997), and nurse technicians (n = 524) in 4 regions of Brazil (North, Northeast, Southeast, and South) from August 2020 to July 2021. We used standardized instruments to screen for common mental disorders (CMD)(SRQ-20), alcohol misuse (AUDIT-C), depression (PHQ-9), anxiety (GAD-7), and post-traumatic stress disorder (PTSD)(PCL-5). Gile's successive sampling estimator was used to produce weighted estimates. We created a three-cluster data set for each HCW category and developed a hierarchical regression model with three levels: individual characteristics; workplace-related aspects; COVID-19 personal experience. The impact of the epidemic moment on the outcomes was also studied. RESULTS: The prevalence of probable CMD was 26.8-36.9%, alcohol misuse 8.7-13.6%, depression 16.4-21.2%, anxiety 10.8-14.2%, and PTSD 5.9-8.0%. We found a stronger association between mental health outcomes and the following factors: history of psychiatric disorders, female gender, and clinical comorbidities (level 1); work overload and family isolation (level 2); sick leave (level 3). Epidemic variables, such as the number of deaths and trend of deaths by COVID-19, had almost no impact on the outcomes. CONCLUSION: An alarmingly high prevalence of depression and anxiety was found in Brazilian frontline HCWs. Individual factors were the most strongly associated with mental health outcomes. These findings indicate the need to develop programs that provide emotional support, identify professionals at risk and refer them to specialized treatment when necessary.

Three methods of manual external chest compressions during microgravity simulation.

INTRODUCTION: Cardiopulmonary resuscitation (CPR) in microgravity is challenging. There are three single-person CPR techniques that can be performed in microgravity: the Evetts-Russomano (ER), Handstand (HS), and Reverse Bear Hug (RBH). All three methods have been evaluated in parabolic flights, but only the ER method has been shown to be effective in prolonged microgravity simulation. All three methods of CPR have yet to be evaluated using the current 2010 guidelines. METHODS: There were 23 male subjects who were recruited to perform simulated terrestrial CPR (+1 G(z)) and the three microgravity CPR methods for four sets of external chest compressions (ECC). To simulate microgravity, the subjects used a body suspension device (BSD) and trolley system. True depth (D(T)), ECC rate, and oxygen consumption (Vo2) were measured. RESULTS: The mean (+/- SD) D(T) for the ER (37.4 +/- 1.5 mm) and RBH methods (23.9 +/- 1.4 mm) were significantly lower than +1 G(z) CPR. However, both methods attained an ECC rate that met the guidelines (105.6 +/- 0.8; 101.3 +/- 1.5 compressions/min). The HS method achieved a superior D(T) (49.3 +/- 1.2 mm), but a poor ECC rate (91.9 +/- 2.2 compressions/min). Vo2 for ER and HS was higher than +1 Gz; however, the RBH was not. CONCLUSION: All three methods have merit in performing ECC in simulated microgravity; the ER and RBH have adequate ECC rates, and the HS method has adequate D(T). However, all methods failed to meet all criteria for the 2010 guidelines. Further research to evaluate the most effective method of CPR in microgravity is needed.

Tele-surgery: a new virtual tool for medical education.

The rapid evolution of telecommunication technology has enabled advances to be made in low cost video-conferencing through the improvement of high speed computer communication networks and the enhancement of Internet security protocols. As a result of this progress, eHealth education programs are becoming a reality in universities, providing the opportunity for students to have greater interaction at live surgery classes by means of virtual participation. Undergraduate students can be introduced to new concepts of medical care, remote second opinion and to telecommunication systems, whilst virtually experiencing surgical procedures and lectures. The better access this provides to the operating theater environment, the patient and the surgeon can improve the learning process for students. An analogical system was used for this experimental pilot project due to the benefits of it being low cost with a comparatively easy setup. The tele-surgery lectures were also transmitted to other universities by means of a Pentium 4 computer using open source software and connected to a portable image acquisition device located in the São Lucas University Hospital. Telemedicine technology has proven to be an important instrument for the improvement of medical education and health care. This study allowed health professionals, professors and students to have greater interaction during surgical procedures, thus enabling a greater opportunity for knowledge exchange.

A comparison between the 2010 and 2005 basic life support guidelines during simulated hypogravity and microgravity.

BACKGROUND: Current 2010 terrestrial (1Gz) CPR guidelines have been advocated by space agencies for hypogravity and microgravity environments, but may not be feasible. The aims of this study were to (1) evaluate rescuer performance over 1.5 min of external chest compressions (ECCs) during simulated Martian hypogravity (0.38Gz) and microgravity (µG) in relation to 1Gz and rest baseline and (2) compare the physiological costs of conducting ECCs in accordance with the 2010 and 2005 CPR guidelines. METHODS: Thirty healthy male volunteers, ranging from 17 to 30 years, performed four sets of 30 ECCs for 1.5 min using the 2010 and 2005 ECC guidelines during 1Gz, 0.38Gz and µG simulations (Evetts-Russomano (ER) method), achieved by the use of a body suspension device. ECC depth and rate, range of elbow flexion, post-ECC heart rate (HR), minute ventilation (VE), peak oxygen consumption (VO2peak) and rate of perceived exertion (RPE) were measured. RESULTS: All volunteers completed the study. Mean ECC rate was achieved for all gravitational conditions, but true depth during simulated microgravity was not sufficient for the 2005 (28.5 ± 7.0 mm) and 2010 (32.9 ± 8.7 mm) guidelines, even with a mean range of elbow flexion of 15°. HR, VE and VO2peak increased to an average of 136 ± 22 bpm, 37.5 ± 10.3 L·min-1, 20.5 ± 7.6 mL·kg-1·min-1 for 0.38Gz and 161 ± 19 bpm, 58.1 ± 15.0 L·min-1, 24.1 ± 5.6 mL·kg-1·min-1 for µG from a baseline of 84 ± 15 bpm, 11.4 ± 5.9 L·min-1, 3.2 ± 1.1 mL·kg-1·min-1, respectively. RPE was the only variable to increase with the 2010 guidelines. CONCLUSION: No additional physiological cost using the 2010 basic life support (BLS) guidelines was needed for healthy males performing ECCs for 1.5 min, independent of gravitational environment. This cost, however, increased for each condition tested when the two guidelines were compared. Effective ECCs were not achievable for both guidelines in simulated µG using the ER BLS method. This suggests that future implementation of an ER BLS in a simulated µG instruction programme as well as upper arm strength training is required to perform effective BLS in space.

Anxiolytic-like activity and GC-MS analysis of (R)-(+)-limonene fragrance, a natural compound found in foods and plants.

The traditional use of essential oils in aromatherapy has offered numerous health benefits. However, few scientific studies have been conducted with these oils to confirm their therapeutic efficacy. (+)-Limonene is a chemical constituent of various bioactive essential oils. The present study reports on the anxiolytic-like effects of (+)-limonene in an elevated maze model of anxiety in mice. At concentrations of 0.5% and 1.0%, (+)-limonene, administered to mice by inhalation, significantly modified all the parameters evaluated in the elevated plus maze test. The pharmacological effect of inhaled (+)-limonene (1%) was not blocked by flumazenil. Analysis of (+)-limonene using gas chromatography-mass spectrometry (GC-MS) showed its volatility to be high. These data suggest possible connections between the volatility of (+)-limonene and its anxiolytic-like effect on the parameters evaluated in the elevated plus maze test. The data indicate that (+)-limonene could be used in aromatherapy as an antianxiety agent.

Desenvolvimento e aplicações de um novo instrumento para estimulação do barorreflexo / Development and application of a new device for barorreflex stimulation

Objetivos: Desenvolver e discutir as possíveis aplicações de um método para estimulação barorreceptora, através de um novo aparelho que permite a realização da manobra de Valsalva de forma automatizada e não-assistida. Métodos: Um manômetro digital foi projetado e desenvolvido pelo Centro de Microgravidade/ FENG-PUCPR para monitorar a pressão intratorácica exercida durante a expiração forçada ou Manobra de Valsalva. Resultados: O equipamento, denominado de Equipamento para Manobra de Valsalva, é constituído de cinco partes principais, sendo elas: um transdutor de pressão (sensor de pressão e amplificador de sinais), um mostrador de caracteres, um mostrador em barra de Diodo Emissor de Luz e um micro-controlador. Testes preliminares indicaram que este novo equipamento permite que um indivíduo realize a manobra de Valsalva de forma correta e sem qualquer assistência durante o procedimento. Conclusões: O aparelho desenvolvido é de fácil manuseio e visualização, leve, portátil e de baixo custo.