Early-life trauma, impulsivity and suicide attempt: a systematic review and meta-analysis.

INTRODUCTION: Suicide is a worldwide health concern and up to date there is no good predictor of it except a previous suicide attempt. Therefore, there are increasing efforts in the understanding of which factors, genetic or environmental, are associated with suicide behaviour. OBJECTIVE: To review evidence of the effect of childhood trauma and impulsivity on suicidal behavior through a systematic review and meta-analysis. METHODS: Searches were conducted on the 12th of June 2021 in the PubMed, Scopus, and Web of Science databases. Two reviewers evaluated each record for eligibility and discussed upon disagreement, when no consensus was reached, a third reviewer was involved to make a decision. RESULTS: A total of 11,530 records were identified through the searches. After duplicates were removed, 6,595 records remained to be screened. The full text was sought for 1,561 records. Our qualitative synthesis included 22 studies, from which 9 were included in the meta-analyses. We found a significant effect of sexual abuse, physical abuse, emotional abuse and physical neglect on suicide attempts in the prisoners, and Substance Use Diorder (SUD) subgroups. Moreover, there was a significant effect of Childhood Trauma Questionnaire (CTQ) total score and emotional neglect dimension for all the subgroups. CONCLUSION: The present study has provided an overview of the state-of-the-art research on childhood trauma and impulsivity and their association with suicidal behavior and quantified their effects on suicide attempts. Hopefully this evidence will be considered in future research and harnessed for clinical gain in detection and treatment of suicide behaviour.

Diagnosis of bipolar and major depressive disorders: The appropriateness of MINI compared to the clinical interview in a sample of patients with mood disorders in tertiary mental health care.

OBJECTIVE: The Mini International Neuropsychiatric Interview (MINI) is one of the most used instruments for the assessment of Mental Disorders, playing an essential role in psychiatric research and in clinical and hospital practice. Despite this, the accuracy of the MINI, when used by a psychiatrist, is poorly studied, particularly in relation to Bipolar Disorder (BD). The early diagnosis of BD and Major Depressive Disorder (MDD) is extremely important, as it provides an opportunity for intervention that can reduce the impact on the patient's daily life and functionality. As such, this study assesses the suitability of MINI for diagnosing BD or MDD in a sample of patients with mood disorders. METHOD: Agreement between the MINI and the clinical interview was assessed in a sample of 347 outpatients by calculating Cohen's kappa, sensitivity, specificity, positive predictive value, negative predictive value, and the area under the curve (AUC). RESULTS: The sample consisted of 347 patients with mood disorders. 279 were women (80.40%), 105 (30.3%) were diagnosed with MDD and 242 (69.7%) with BD from the assessment performed in the clinical interview. In the MINI assessment, 97 individuals (28%) were classified with a diagnosis of MDD and 250 (72%) with BD. We found a sensitivity of 87.2% and specificity of 62.8% for the MINI in the diagnosis of BD and a Cohen's kappa between the MINI and the clinical interview of 0.51. The AUC was 0.75. CONCLUSIONS: MINI has greater sensitivity (87.2%) for the diagnosis of BD and greater specificity (87.2%) for the diagnosis of MDD. In addition, the moderate Cohen kappa (0.51) and AUC (0.75) values between the MINI and the clinical interview are acceptable when considering most available psychiatric diagnostic tools.

Leptospirose e seu aspecto ocupacional - Revisão de literatura / Leptospirosis and its occupational aspect - Literature review / Leptospirosis y su aspecto laboral - Revisión de literatura

A leptospirose é uma das zoonoses mais difundidas do mundo, no Brasil a doença é endêmica em todas as unidades da federação e epidêmica, principalmente, em períodos chuvosos. Sua ocorrência está relacionada às precárias condições de infraestrutura sanitária e alta infestação de roedores infectados. As inundações propiciam a disseminação do agente causal no ambiente, facilitando a eclosão de surtos. Nesta revisão de literatura objetivou-se mostrar o âmbito profissional/ocupacional que é de grande relevância para a saúde pública, atingindo diferentes categorias profissionais como agricultores, pecuaristas, biólogos, trabalhadores de arrozais, trabalhadores de saneamento ambiental, médicos veterinários, técnicos de laboratório, manipuladores de produtos de origem animal entre outras. Neste contexto, a leptospirose firma-se como uma doença de grande importância social e econômica, por apresentar elevada ocorrência, em determinadas áreas, alto custo hospitalar para o tratamento e ausência ao trabalho, como também por sua mortalidade Desta forma, faz necessária a intervenção dos gestores de saúde para redução dos índices desta enfermidade.

Leptospirosis is one of the most widespread zoonoses in the world. In Brazil, the disease is endemic in all Brazilian states and epidemic especially in the rainy periods, whose proliferation becomes favorable as a consequence of some environmental factors. Its occurrence is related to the poor sanitary infrastructure conditions and high infestation of infected rodents. Floods favor the spread of the causal agent in the environment, facilitating the emergence of outbreaks. This literature review aimed at showing the professional/occupational area that is of greatest importance to public health, affecting different professional categories such as farmers, ranchers, biologists, rice picking workers, environmental sanitation workers, veterinarians, laboratory technicians, handlers of animal products, among others. In this context, leptospirosis is considered a disease of great social and economic importance, due to its high incidence in certain areas, high hospital costs and loss of working days, as well as its lethality. Thus, the intervention of health managers is necessary to reduce the rates of this disease.

La leptospirosis es una de las zoonosis más extendidas en el mundo, en Brasil la enfermedad es endémica en todos los estados brasileños y epidémica, especialmente en períodos de lluvia. Su aparición está relacionada a las precarias condiciones de infraestructura de salud y de alta infestación de roedores infectados. Las inundaciones favorecen la propagación del agente causal en el entorno, facilitando la aparición de brotes. En esta revisión de literatura destinada a mostrar el área profesional / ocupacional que es de gran importancia para la salud pública, alcanzando diversas categorías profesionales como agricultores, ganaderos, biólogos, trabajadores de arrozales, trabajadores de saneamiento ambiental, veterinarios, técnicos de laboratorio, manipuladores de productos de origen animal, entre otros. En este contexto, la leptospirosis se hace una enfermedad de gran importancia social y económica, debido a su alta incidencia en determinadas zonas, los altos costos hospitalarios y pérdida de días de trabajo, así como por su mortalidad. Por lo tanto, se hace necesario la intervención de los administradores de salud para reducción de las tasas de esta enfermedad.

Chromosome instability and oxidative stress markers in patients with ataxia telangiectasia and their parents.

Ataxia telangiectasia (AT) is a rare neurodegenerative disorder, inherited in an autosomal recessive manner. Total blood samples were collected from 20 patients with AT, 13 parents of patients, and 17 healthy volunteers. This study aimed at evaluating the frequency of chromosomal breaks in spontaneous cultures, induced by bleomycin and ionizing radiation, and further evaluated the rates of oxidative stress in AT patients and in their parents, compared to a control group. Three cell cultures were performed to each individual: the first culture did not receive induction to chromosomal instability, the second was exposed to bleomycin, and the last culture was exposed to ionizing radiation. To evaluate the rates of oxidative stress, the markers superoxide dismutase (SOD), catalase (CAT), and thiobarbituric acid (TBARS) were utilized. Significant differences were observed between the three kinds of culture treatments (spontaneous, bleomycin, and radiation induced) and the breaks and chromosomal aberrations in the different groups. The oxidative stress showed no significant differences between the markers. This study showed that techniques of chromosomal instability after the induction of ionizing radiation and bleomycin are efficient in the identification of syndrome patients, with the ionizing radiation being the most effective.

A prevalência de estresse em uma amostra de estudantes do curso de medicina da Universidade Federal do Rio Grande do Sul / Prevalence of stress in a sample of medical students of Universidade Federal do Rio Grande do Sul

Introdução: O ingresso na Faculdade de Medicina representa uma transição a um novo estilo de vida e maior grau de exigência curricular. O estresse pode influenciar o desempenho acadêmico e as habilidades para tomar decisões e estabelecer uma adequada relação médico-paciente. O presente estudo avaliou a prevalência de estresse e fatores associados em uma amostra de estudantes da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS) através do Inventário de Sintomas de Stress para Adultos de Lipp (ISLL). Métodos: Estudo transversal não controlado, amostra aleatória (168 alunos). Instrumentos: ISLL, questionário com dados demográficos, uso de álcool e outras substâncias e sintomas de ansiedade. Resultados: Encontrou-se uma prevalência de estresse de 51,3% (IC95% 40,2-62,2), com maior prevalência de sintomas físicos do que psíquicos. A partir do sexto semestre os alunos apresentaram maior prevalência de estresse (55,3%), sem diferença estatisticamente significativa entre os semestres. O uso regular de álcool (43,6%) e estimulantes foi semelhante entre os alunos com e sem estresse (P = 0,63). Entre os alunos com estresse, 40% afirmaram já ter experimentado sintomas de pânico, enquanto apenas 5,3% dos sem estresse referiram esses sintomas (P <0,001). Entre os alunos com estresse, 90% relataram presença de sintomas de ansiedade nos últimos 6 meses, enquanto apenas 39,5% dos sem estresse o referiram (P < 0,001). Conclusão: Nossos achados apontam para a necessidade de investigar as causas da alta prevalência de estresse encontrada, a fim de propor medidas preventivas e/ou oferecer apoio psicológico para os estudantes, proporcionando uma melhor formação médica.

Background: Entering Medical School represents a transition toward a new lifestyle and higher curricular standards. Stress can influence academic performance and decision-making skills and establish a proper physician-patient relationship. This study examined the prevalence of stress and associated factors in a sample of medical students of Universidade Federal do Rio Grande do Sul (UFRGS) using Lipp’s Adult Stress Symptoms Inventory (ASSI). Methods: This is a cross-sectional, uncontrolled study using a random sample (168 students). Instruments: ASSI, questionnaire with demographic data, use of alcohol and other substances and anxiety symptoms. Results: There was a prevalence rate of stress of 51.3% (95%CI 40.2-62.2), with higher prevalence of physical symptoms than psychological symptoms. From the sixth semester students had higher prevalence of stress (55.3%), with no statistically significant difference between semesters. Regular use of alcohol (43.6%) and stimulants was similar between students with and without stress (P= 0.63). Among students with stress, 40% reported having already experienced panic symptoms, while only 5.3% of those without stress reported such symptoms (P <0.001). Among students with stress, 90% reported presence of anxiety symptoms in the last 6 months, while such symptoms were present in only 39.5% of those without stress (P <0.001). Conclusion: These findings suggest the need to investigate the causes of high prevalence of stress to propose preventive measures and/or to provide psychological support for students, providing better medical training.