The association of continuous-use medications and sleep parameters in a sample of working adults.

PURPOSE: Although polypharmacy is linked to health outcomes in the elderly, the use of multiple medications is increasing in middle-aged adults. This study analyzed whether or not the increased number of continuous-use medications (C-UM) is associated with objective and subjective sleep parameters in a working population. METHODS: Cross-sectional study with schoolteachers from public schools in Londrina, Brazil. The participants were classified according to the self-reported number of C-UM. Sleep data were obtained with actigraphy and a concomitant sleep diary for 7 days. The analyses were adjusted for socio-demographic, lifestyle, and morbidity variables. RESULTS: A total of 17% of the participants were classified as using ≥3C-UM. In fully adjusted analyses, the use of ≥3C-UM was associated with lower actigraphic sleep duration (<6 h) (odds ratio [OR] = 2.51; 95% confidence interval [CI] = 1.01,6.21), higher actigraphic sleep onset latency (SOL) (OR = 2.65; 95%CI = 1.00,7.02), and with a higher number of awakenings during sleep measured by actigraphy (OR = 3.30; 95%CI = 1.32,8.28). The use of ≥3 C-UM was also associated with higher SOL (OR = 3.76; 95%CI = 1.36,10.5) and lower sleep efficiency (OR = 11.6; 95%CI = 2.92,46.1), as measured with the sleep diary. A 1-unit increment in the number of continuous-use medications was associated with higher self-reported SOL and lower subjective sleep efficiency. CONCLUSION: The continuous use of ≥3 medications is associated with worse objective and subjective parameters of sleep duration and quality in schoolteachers.

Working conditions and illicit psychoactive substance use among truck drivers in Brazil.

BACKGROUND: The aim of this study was to identify the role that working conditions play in predicting the consumption of illicit psychoactive substances (IPS) among truck drivers. METHODS: This cross-sectional study was conducted with truck drivers who transport grains to Paranaguá Port, PR, Brazil. The truck drivers were interviewed, and they completed a self-administered questionnaire regarding their sociodemographics, lifestyles, working conditions, and consumption of IPS over the past 30 days. The statistical analysis included logistic regression models progressively adjusted for sociodemographic and lifestyle variables. RESULTS: A total of 670 male drivers with a mean age of 41.9 (±11.1) years were assessed. The prevalence of IPS consumption over the past 30 days was 10.9% (n=73). The drugs used primarily consisted of amphetamines (n=61). After adjusting for working characteristics, sociodemographic and lifestyle variables, the following working conditions were associated with the consumption of IPS: driving mostly at night (OR=3.91; 95% CI 1.75 to 8.74), driving while tired (OR=2.26; 95% CI 1.31 to 3.89), and earning a higher monthly income (OR=2.08; 95% CI 1.16 to 3.72). Drivers who were 39 years old or younger (OR=2.11; 95% CI 1.05 to 4.25) and not living with a partner (OR=2.22; 95% CI 1.17 to 4.22) were also more likely to consume IPS. CONCLUSIONS: Driving mostly at night, being tired, and earning more increase the use of IPS among truck drivers, regardless of other working characteristics, sociodemographic, and lifestyle variables.

Psychoactive substance use by truck drivers: a systematic review.

The aim of this study was to summarise the scientific evidence on the prevalence of psychoactive substance use and on the factors associated with their intake among truck drivers. A systematic review was performed in the databases PubMed, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences, and Cochrane and 36 cross-sectional studies were identified with quantitative results about the use of psychoactive substances by truck drivers. Out of these, 28 were carried out in countries with large land areas and 23 obtained their information through self-reporting. The most frequently studied substances were alcohol (n=25), amphetamines (n=17), marijuana (n=16) and cocaine (n=13). The prevalence of the use of these substances greatly varied: alcohol (0.1-91.0%); amphetamines (0.2-82.5%), marijuana (0.2-29.9%), cocaine (0.1-8.3%). The frequency of substance use was lower in studies that investigated the presence of these substances in biological samples than in those based on self-reported use. In 12 studies that evaluated factors associated with the intake of psychoactive substances, the following stood out: younger age, higher income, longer trips, alcohol consumption, driving in the night shift, travelling interstate routes, long or short sleep, fewer hours of rest, little experience of the driver, connection with small and medium sized companies, income below levels determined by labour agreements, productivity-based earnings and prior involvement in accidents. The frequency of psychoactive substance use by truck drivers seems to be high, although that greatly varies according to the type of substance and the method of collecting the information. The use of these substances was mainly associated with indicators of poor working conditions.

Analysis of the dimensional structure of the Patient Health Questionnaire-9 (PHQ-9) in undergraduate students at a public university in Brazil.

BACKGROUND: The prevalence of mental health-related problems has increased in recent years, especially among young adults, such as university students. Several measurement instruments have been developed to identify individuals at risk for depression, such as the Patient Health Questionnaire-9 (PHQ-9). However, different dimensional structures of the PHQ-9 can make it difficult to interpret and compare research results. To analyze the dimensional structure and convergent validity of the PHQ-9 in university students. METHODS: This is a cross-sectional study developed with 3163 students enrolled in different courses at a university in southern Brazil. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to identify the most parsimonious and best-fitting model. Convergent validity was verified through the significant relationship (p < 0.05) between theoretically related constructs (sleep quality, alcohol consumption, and physical activity practice). RESULTS: The EFA resulted in two models (unidimensional and two-dimensional), with better indices for the two-dimensional model. In the CFA, both the unidimensional and the two-dimensional models presented satisfactory fit indices that were higher for the unidimensional model. LIMITATIONS: The analysis of convergent validity is limited by the absence of a gold standard for comparison. CONCLUSIONS: This study provided support for the unidimensional structure of the PHQ-9, with adequate convergent validity, among university students.

[Determining factors for neonatal mortality in a city in the southern region of Brazil]. / Fatores determinantes da mortalidade neonatal em um município da Região Sul do Brasil.

This is an ecological quantitative study to identify risk factors that determined neonatal death between the years of 2000 to 2009 in Londrina, Paraná, using data from Birth Certificates, Death Certificates and Infant Death Investigation Forms. The variables maternal age, years of education, family income, occupation, marital status, type of delivery, and number of prenatal appointments were not associated to neonatal death. To the contrary, birth weight, gestational age, Apgar score at 1 and 5 minutes, and place of birth were identified as statistically significant variables. More than 73.0% of newborns died within early neonatal period. The predominant basic cause of death was perinatal problems (77.7%), 72.6% of which were preventable, and the majority of which could be reduced with adequate control over pregnancy/birth. These results highlight the need for investments in prevention of premature delivery by improvement of health care in prenatal and birth periods, in an equanimous, accessible and comprehensive manner in all levels of maternal and child health care.

Association between self-reported food intake and subjective sleep quality among truck drivers in a city in Southern Brazil.

Introduction: Sleep is an activity of great importance for maintaining the homeostasis of the human body and some components may interfere with the quality of sleep, including the pattern of food consumption. Truck drivers may constitute a population particularly sensitive to this association, since they are routinely exposed to situations that may interfere with food intake and sleep quality. Thus, this study investigated the association between self-reported food intake and sleep quality in truck drivers. Methods: This was a cross-sectional study, with drivers who traveled in a city in southern Brazil. Food intake was evaluated through the average of food intake over the last 30 days. Food intake was evaluated in two forms: division in food groups and evaluation only tryptophan-rich foods. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). In addition to the descriptive analysis, to identify possible associations between food intake and sleep quality, linear regression, crude and adjusted for confounding variables, were performed to obtain the Beta and Beta adjusted (Betaadj), respectively, and p-value. Results: A total of 352 truck drivers, mostly males, mean age 48.4 (±11.6) years, with a frequent consumption of meat, fruits, vegetables, sweets, and energy drinks participated in this study. The frequent consumption of dairy products (Betaadj: --0.614. p-value 0.004) and fruits (Betaadj: --0.342. p-value 0.034) was associated with lower PSQI score, while the consumption of energy drinks was associated with a higher PSQI score (Betaadj: 0.923. p-value <0.001). The frequency of consumption of tryptophan-rich foods was not associated with sleep quality. Conclusion: Fruits and dairy products are associated with better subjective sleep quality, while energy drinks are associated with worse sleep quality in truck drivers, whereas dietary tryptophan-rich foods intake was not associated with sleep quality.

Job satisfaction and absenteeism among Brazilian teachers.

Introduction: Teachers, especially those in primary education, face unfavorable working conditions, which lead to job dissatisfaction and affect their physical and mental health, thus contributing to absenteeism. Objectives: To verify the association between lower job satisfaction and absenteeism due to short and long term health problems in elementary and hight school teachers. Methods: This observational, analytical, individual, cross-sectional, retrospective cohort study included 899 elementary and high school teachers. Absenteeism was determined by self-reported absences in the last 12 months for health reasons, categorized as short term (1-7 days) or long term (≥8 days). Job satisfaction was measured by the Occupational Stress Indicator scale, categorized as lower satisfaction (≤25th percentile) or higher satisfaction (>25th percentile). Multinomial logistic regression was used, and the odds ratio was calculated as a measure of association. Results: The majority of the teachers were women (68.3%) and were permanently employed (69.1%); the mean age was 42 (SD, 10) years. Women, younger teachers, permanent employees, those reporting chronic pain or illness, and those reporting a moderate/poor level of physical or mental work capacity had a higher risk of absenteeism. Lower job dissatisfaction was associated with short-term and long-term absenteeism. Job satisfaction was only related to short-term absenteeism after the adjustments made. Conclusions: There was an association between absenteeism and lower job satisfaction, which indicates that measures to improve job satisfaction are necessary.

Introdução: Professores, especialmente os da educação básica, têm enfrentado inúmeras condições desfavoráveis de trabalho, o que gera insatisfação no trabalho, com prejuízo à sua saúde física e mental, contribuindo para o absenteísmo. Objetivos: Verificar a associação entre menor satisfação no trabalho e absenteísmo por problema de saúde de curto e longo prazos em professores do ensino fundamental e médio. Métodos: Estudo observacional, analítico, individual, transversal, retrospectivo de coorte com professores do ensino fundamental e médio (n = 899). O absenteísmo foi determinado pelo relato de falta nos últimos 12 meses por motivo de saúde, categorizado em curto prazo (1 a 7 dias) e longo prazo (8 dias ou mais). A satisfação no trabalho foi mensurada pela escala Occupational Stress Indicator, categorizada em menor satisfação (até o percentil 25) e maior satisfação (acima do percentil 25). Foi utilizada a regressão logística multinomial, com cálculo da odds ratio como medida de associação. Resultados: Dos professores avaliados, a maioria era do sexo feminino (68,3%), tinham média de idade de 42 ± 10 anos e apresentavam vínculo estatutário (69,1%). As chances de absenteísmo foram maiores entre os professores do sexo feminino, mais jovens, com vínculo estatutário, que referiram dor ou doença crônica e que relataram capacidade física ou mental para o trabalho moderada/baixa. Professores menos satisfeitos apresentaram maiores chances de absenteísmo de curto e de longo prazo. Após os ajustes realizados, a satisfação no trabalho associou-se apenas ao absenteísmo de curto prazo. Conclusões: Houve associação entre absenteísmo e menor satisfação no trabalho, tornando-se necessárias medidas para melhorar a satisfação no trabalho.

First report of an accident caused by Jaguajir agamemnon (C.L. Koch, 1839) (Scorpiones, Buthidae) in Paraná state, Brazil.

We report the first pediatric case of a Jaguajir agamemnon scorpion sting. This case occurred in the state of Paraná and is the first record of this species in southern Brazil. The patient was admitted within 15 min, with pain, local edema, erythema, whole-body pruritus, and tongue paresthesia within the first two hours, which disappeared thereafter. The patient's condition was considered mild, with a positive outcome, and she recovered completely.

Free-time physical activity and pain perception: An analysis of daily records from Brazilian teachers.

The sensation of pain is frequent in teachers and its relationship with the practice of free-time physical activity still needs more scientific evidence. This study analyzed the association between free-time physical activity and pain symptoms experienced by teachers during the day and at bedtime. In this cross-sectional study, data were obtained through individual interviews and the fulfillment of an activity diary by teachers from a city located in southern Brazil. Statistical analysis was performed using logistic regression adjusted for sociodemographic, lifestyle and health variables. Among the 141 teachers included, pain perception was reported during the day by 66.7% and at bedtime by 66.0%. Analyses adjusted for sex, age, body mass index and time spent watching television indicated that practicing more than 240 minutes/week of free-time physical activity was associated with a lower likelihood of reported pain during the day (odds ratio, OR=0.18; 95% confidence interval, CI: 0.06-0.54) and at bedtime (OR=0.28; 95% CI: 0.10-0.79) compared to practicing ≤60 minutes/week of free-time physical activity. These associations lost statistical significance after the additional adjustment for depressive symptoms. In summary, this study showed that teachers who practiced more than 240 minutes/week of physical activity in free-time were less likely to report pain during the day and at bedtime. Depressive symptoms had an important confounding effect on this association. A multidisciplinary approach can optimize preventive strategies for pain prevention and management through health education programs in the workplace.

Working conditions and common mental disorders in prison officers in the inland region of the state of São Paulo, Brazil. / Condições de trabalho e transtornos mentais comuns em agentes penitenciários do interior do estado de São Paulo, Brasil.

The prison officer profession is characterized by working in risky situations, which can harm officers' mental health. This research aimed to analyze prison officers' working conditions associated with Common Mental Disorders (CMD). This cross-sectional study was conducted with prison officers in four penitentiary units in the inland region of the State of São Paulo, Brazil, from January to August 2019. The Self-Reporting Questionnaire (SRQ-20) tool was employed to quantify the presence of CMDs. Poisson regression verified the association between variables with robust variance and adjusted for confounding factors to estimate the prevalence ratio (PR) and 95% confidence interval (CI). The study population comprised 331 prison officers (ASP), with a 33.5% frequency of CMDs. CMDs were higher among prison officers with a worse perception of working conditions (PR: 1.13; 95%CI%: 1.03-1.24), who suffered insults (PR: 1.18; 95%CI: 1.08-1.29), psychological harassment (PR: 1.23; 95%CI: 1.11-1.36) and sexual harassment (PR: 1.20; 95%CI: 1.03-1.40) in the last 12 months. CMDs were associated with work-related variables, such as worse environmental conditions within the prison and psychological and sexual violence.

A profissão de agente de segurança penitenciária (ASP) se caracteriza pelo trabalho em situações de perigo, o que pode desencadear prejuízos à sua saúde mental. O objetivo desta investigação foi analisar as condições de trabalho associadas aos transtornos mentais comuns (TMC) em ASP. Trata-se de um estudo transversal, realizado com ASP de quatro unidades prisionais do interior do estado de São Paulo, de janeiro a agosto de 2019. Para mensurar a presença de TMC, utilizou-se o instrumento Self-Reporting Questionnaire (SRQ-20). A associação entre as variáveis foi verificada por meio de regressão de Poisson com variância robusta, ajustada por fatores de confusão para a estimação da razão de prevalência (RP) e intervalo de confiança (IC) de 95%. A população de análise foi constituída por 331 ASP, com frequência de TMC de 33,5%. A presença de TMC foi mais elevada entre os ASP com pior percepção sobre as condições de trabalho (RP: 1,13; IC95%: 1,03-1,24), que sofreram insultos (RP: 1,18; IC95%: 1,08-1,29), assédio moral (RP: 1,23; IC95%: 1,11-1,36) e assédio sexual (RP: 1,20; IC95%: 1,03-1,40), nos últimos 12 meses. O TMC apresentou associação com variáveis relacionadas ao trabalho, tais como piores condições do ambiente no interior do cárcere e ocorrência de violências psicológica e sexual.

[The use of anticholinergic drugs and associated factors in middle-aged adults and the elderly]. / O uso de fármacos anticolinérgicos e fatores associados em adultos de meia-idade e idosos.

The objective of this article was to describe the use of anticholinergic drugs and possible factors associated with their use, in middle-aged adults and in the elderly. This is a cross-sectional study, based on data from a population-based study called VIGICARDIO. All respondents aged 44 or older interviewed in 2015 were included. Anticholinergic Drug Scale (ADS) was used to determine anticholinergic burden (ACB), categorized as significant (≥3) and non-significant (< 3). Poisson regression was conducted with crude and adjusted analysis to investigate the factors associated with ACB. There was a prevalence of 20.7% of significant ACB among respondents, higher among middle-aged adults (24.1%). After adjusted analysis, significant ACB (≥ 3) remained in the non-elderly age group with polypharmacy and sporadic use of two or more drugs. In the elderly, sporadic use of two or more medications and hospitalization in the last year continued to be associated with significant ACB. The results indicate a higher prevalence of ACB among middle-aged adults, polymedicated and in sporadic use of medications, which suggests that the investigation of the use of anticholinergicsin this age group requires greater attention.

O objetivo deste artigo foi descrever o uso de medicamentos anticolinérgicos e possíveis fatores associados ao seu uso em adultos de meia idade e idosos. Trata-se de um estudo transversal em que foram incluídos todos os respondentes de 44 anos ou mais entrevistados em 2015. Foi utilizada a Anticholinergic Drug Scale (ADS) para determinação da carga anticolinérgica (CAC), categorizada em elevada (≥ 3) e não-elevada (< 3). Conduziu-se regressão de Poisson com análise bruta e ajustada para investigar os fatores associados à CAC, com cálculo da razão de prevalência (RP) e intervalo de confiança 95% (IC95%). Constatou-se prevalência de 20,7% de CAC elevada entre os respondentes, maior entre adultos de meia idade (24,1%). Após análise ajustada, mantiveram-se associadas à CAC elevada na faixa etária não idosa a polifarmácia e uso esporádico de dois ou mais medicamentos. Nos idosos, continuaram associados à CAC elevada o uso esporádico de dois ou mais medicamentos e internação no último ano. Os resultados indicam maior prevalência de CAC entre adultos de meia-idade, polimedicados e em uso esporádico de medicamentos, o que sugere que a investigação do uso de anticolinérgicos nessa faixa etária demanda maior atenção.

Bidirectional associations between chronic low back pain and sleep quality: A cohort study with schoolteachers.

AIMS: Although both chronic low back pain (cLBP) and sleep problems are prevalent among active workers, the relation between these variables is not well established. This study aimed to examine the bidirectional association between cLBP and sleep in schoolteachers. METHODS: The Pittsburgh Sleep Quality Index (PSQI) and cLBP were self-reported by 530 schoolteachers in Londrina, Brazil, at baseline and after 2 years of follow-up. Generalized estimating equations were adjusted for sociodemographic, lifestyle and mental health variables. RESULTS: Poor sleep quality at baseline was associated with cLBP at follow-up after adjusting for sociodemographic and lifestyle variables (OR=1.61; 95% confidence interval [95% CI]=1.06, 2.47). Changes in the PSQI score over time were also associated with a higher likelihood of cLBP at follow-up (OR=1.13; 95% CI=1.07, 1.20 for each 1-point increase in the PSQI score), regardless of mental health condition. cLBP at baseline was associated with worse sleep quality at follow-up after adjusting for sociodemographic and lifestyle variables (OR=1.56; 95% CI=1.02, 2.37). The presence of cLBP also changed the PSQI score over time (ß coefficient=1.153; 95% CI=0.493, 1.814). CONCLUSIONS: Worse sleep quality was prospectively and bidirectionally associated with cLBP. Concretely, changes in PSQI values after 2 years of follow-up increased the likelihood of reporting cLBP, and baseline cLBP was associated with sleep quality worsening (i.e., higher score in the PSQI). Mental health conditions such as self-rated health, depression and anxiety play a relevant confounding role in the bidirectional associations between sleep and chronic low back pain.

CLINICAL AND EPIDEMIOLOGICAL ANALYSIS OF SUICIDE ATTEMPTS IN CHILDREN ASSISTED BY A POISON CONTROL CENTER.

OBJECTIVE: To assess suicide attempts in children seeking care at a Poison Control Center. METHODS: Cross-sectional study with children (<12 years old) that attempted suicide and were cared at the Poison Control Center in Londrina, Paraná, Southern Brazil, from April 1985 to December 2018. RESULTS: We identified 59 children, most of them females (74.6%), who used only one product (77.9%). Among the products involved, medications were the most important ones (88.1%). Neurological/psychiatric/muscular manifestations (61.0%) were the main symptoms presented. The main reason identified for the suicide attempt was conflicts with family and/or friends (27.1%). Suicide attempts were more frequent in 2001-2003 and 2016-2018. CONCLUSIONS: Suicide attempts occurred mainly in female children with a single agent (mainly medications), and the main reason was family conflicts..

[Unhealthy eating habits and associated risk factors among truck drivers]. / Comportamentos alimentares de risco à saúde e fatores associados entre motoristas de caminhão.

The scope of this article is to identify risk factors associated with unhealthy eating habits among truck drivers. It involved a cross-sectional study carried out with truck drivers individually interviewed at the Port of Paranaguá in the State of Paraná, Brazil. Information was obtained on the consumption of fruit, vegetables, fried salted food, sweetened beverages, and the removal of visible fat from red meat and of skin from chicken meat. Hierarchical Poisson regression models were applied to identify factors associated with unhealthy eating habits. Of those interviewed (n = 670), 53.1% had four or more unhealthy eating habits. This condition was associated with age less than 40 years (prevalence ratio, PR = 1.49; 95% confidence interval, CI = 1.28-1.73), moderate, low or very low ability to exercise the profession (PR 1.28; 95% CI 1.08-1.52), not taking physical exercise in free time (PR = 1.66; 95%CI = 1.38- 2.00), overall self-reported eating habits as poor or very poor (RP = 1.25; IC95% = 1.05-1.49) and body mass index < 25 Kg/m2 (PR = 1.22; 95% CI = 1.05-1.43). More than half of the truck drivers revealed unhealthy eating habits, highlighting the need for strategies to rectify these habits.

O objetivo deste artigo é identificar fatores associados aos comportamentos alimentares de risco à saúde entre motoristas de caminhão. Trata-se de um estudo transversal realizado com motoristas de caminhão entrevistados no Porto de Paranaguá. Foram obtidas informações sobre o consumo de frutas, verduras e legumes, salgados fritos, bebidas açucaradas industrializadas e doces, e retirada de gordura visível de carne vermelha e da pele de carne de frango. Modelos hierarquizados foram construídos para identificar fatores associados aos comportamentos alimentares de risco à saúde. Dos entrevistados (n = 670), 53,1% apresentaram quatro ou mais comportamentos alimentares de risco à saúde. Tal condição associou-se com idade inferior a 40 anos (RP = 1,49; IC95% = 1,28-1,73), capacidade para exercer a profissão referida como moderada/baixa/muito baixa (RP 1,28; IC 95% 1,08-1,52), não praticar atividade física no tempo livre (RP = 1,66; IC95% = 1,38-2,00), qualidade da alimentação referida como ruim/muito ruim (RP = 1,25; IC95% = 1,05-1,49) e índice de massa corporal (IMC) < 25 Kg/m2 (RP = 1,22; IC95% = 1,05-1,43). Mais da metade dos motoristas de caminhão apresentaram comportamentos alimentares de risco à saúde, reforçando a necessidade de estratégias de incentivo à redução desses hábitos.

Patient safety culture: perception of nursing professionals in high complexity institutions.

OBJECTIVES: to analyze the perception of nursing professionals about patient safety culture in three highly complex hospital institutions. METHODS: descriptive and quantitative study with professionals working in care. The Hospital Survey on Patient Safety Culture questionnaire was applied, classifying its dimensions according to the percentage of positive responses (strengthened: ≥75.0%; potential for improvement: <75.0% to> 50.0%; weakened: ≤50.0%). RESULTS: four hundred sixty-seven professionals (79.6%), mostly women (88.4%), nursing technicians/assistants (57.2%), 20 to 39 years (60.8%), less than five years in the institution (57.8%) and exclusive bond (79.2%) participated in the study. Safety culture was considered fragile, seven dimensions assessed as such, highlighting "Openness to communication" and "Non-punitive responses to errors" with <30.0% positive responses. CONCLUSIONS: evidence of the need for discussion of the subject and strategies for change that promote quality and safety of care.

Prospective association between burnout and road traffic accidents in teachers.

We investigated whether burnout (emotional exhaustion, depersonalization and reduced professional efficacy) is a risk factor for traffic accidents. A prospective cohort study was conducted with 509 school teachers. The teachers were interviewed in 2012-2013, and the Maslach Burnout Inventory was applied. After 2 years, the teachers were interviewed again to determine the occurrence of traffic accidents. Poisson regression models with robust variance were used to adjust the analyses. Relative risks (RRs) and 95% confidence intervals (95%CIs) were calculated to assess changes in c-units in the scores of each Burnout dimension, with c equal to 1, 5 and 10 units. The incidence rate of road traffic accidents at follow-up was 10.8%. After adjustments for sex, age, high workload/exposure to the traffic environment, daily consumption of alcoholic beverages and the other dimensions of burnout, depersonalization was a risk factor for traffic accidents. For each 1- and 10-point increase in the depersonalization score, the risk increased by 8 and 119%, respectively. Emotional exhaustion was not associated with these accidents. Increases in the professional efficacy score increased the risk of traffic accidents. The association of depersonalization with future road traffic accidents reinforces the need for measures to improve teachers' work conditions to reduce burnout.

Trends of drug-related poisoning cases attended to at a poison control center. / Tendências de eventos toxicológicos relacionados a medicamentos atendidos por um Centro de Informações Toxicológicas.

INTRODUCTION: Drug-related poisonings have a high impact on morbidity and mortality, representing the first cause of intoxication in Brazil. OBJECTIVE: To describe the trends of cases of drug-related poisonings attended to by a poison control center. METHOD: A quantitative approach (cross-sectional trend study) with data analysis of cases of drug-related poisonings attended to at the Poison Control Center of University Hospital of the State University of Londrina. Data were collected from service notification records for the period 1985 to 2014. For statistical analysis, a simple linear regression model was used. RESULTS: Of the 36,707 cases attended to by the service, 22.5% (n = 8,608) were drug-related poisonings. There was an increase in the proportion of cases for both sexes (R2 = 0.195, p = 0.014) and males (R2 = 0.403, p < 0.001). There was a trend towards a higher proportion of cases involving the analgesic, anti-inflammatory and immunosuppressive drug classes (R2 = 0.521, p = 0.018), antidepressants (R2 = 0.923, p < 0.001) and antipsychotics (R2 = 0.869; p < 0.001). Antibiotics showed a trend toward a lower proportion of cases (R2 = 0.773, p = 0.001). CONCLUSIONS: There was a trend for a higher proportion of cases of drug-related poisonings in males. Also, there was an increased trend towards cases involving analgesics/anti-inflammatories/immunosuppressants, antidepressants and antipsychotics.

INTRODUÇÃO: Os eventos toxicológicos relacionados a medicamentos têm alto impacto na morbimortalidade, representando a primeira causa de intoxicação no Brasil. OBJETIVO: Descrever as tendências de casos de eventos toxicológicos relacionados a medicamentos atendidos por um Centro de Informações Toxicológicas. MÉTODO: Estudo com abordagem quantitativa (transversal e de tendência), com análise dos dados referentes aos casos de eventos toxicológicos relacionados a medicamentos atendidos pelo Centro de Informações Toxicológicas do Hospital Universitário da Universidade Estadual de Londrina. Os dados foram coletados das fichas de atendimento, referentes ao período de 1985 a 2014. Para a análise estatística, utilizou-se um modelo de regressão linear simples. RESULTADOS: Dos 36.707 casos atendidos pelo serviço, 22,5% (n = 8.608) foram eventos toxicológicos relacionados a medicamentos. Houve um aumento da proporção de casos em ambos os sexos (R2 = 0,195; p = 0,014) e no sexo masculino (R2 = 0,403; p < 0,001). Detectou-se tendência de elevação da proporção de casos envolvendo a classe de analgésicos, anti-inflamatórios e imunossupressores (R2 = 0,521; p = 0,018), antidepressivos (R2 = 0,923; p < 001) e antipsicóticos (R2 = 0,869; p < 0,001). Os antimicrobianos apresentaram tendência de redução da proporção de casos (R2 = 0,773; p = 0,001). CONCLUSÕES: Observou-se tendência de aumento da proporção de casos de eventos toxicológicos relacionados a medicamentos no sexo masculino. Também houve aumento nas tendências envolvendo analgésicos/anti-inflamatórios/imunossupressores, antidepressivos e antipsicóticos.

A Distance-Learning Course to Improve Drug-Dispensing Behaviors Among Brazilian Community Pharmacists.

Objective. To evaluate the effectiveness of a distance-learning course in the training of pharmacists in drug dispensing. Methods. This interventional study was carried out with community pharmacists throughout Brazil. A 12-week distance-learning course was conducted. Pharmacists' knowledge and performance during drug dispensing were evaluated before and after completion of the course. Results. Community pharmacists' knowledge of drug dispensing was greater after completing the distance-learning course than before (mean=5.7, SD=2.8 points vs mean=3.8, SD=1.9 points, respectively). However, no improvement was observed in pharmacists' drug-dispensing practice. Almost all participants (96.5%) considered that they were more qualified to perform the drug dispensing after the course. There were 1492 pharmacists enrolled in the course, of which 1061 were included in the study, and 472 completed the surveys. Only pharmacists from Ribeirão Preto, Brazil, were invited to take the mytery shopper evaluation (n=26). However, 10 pharmacists completed the mystery shopper encounter. Conclusion. A distance-learning course was effective in improving community pharmacists' knowledge. However, the course did not seem to improve overall drug-dispensing performance. Additional educational strategies should be adopted in future studies to address this gap.

Working conditions and sleepiness while driving among truck drivers.

Objective: The objective of this study is to identify the role of working conditions as predictors of sleepiness while driving among truck drivers. Methods: This was a cross-sectional study carried out among truck drivers who transported grains to Paranaguá Port, Paraná, Brazil. The truck drivers were interviewed and completed a self-administered questionnaire to collect data on sociodemographic and behavioral variables, working conditions, consumption of illicit psychoactive substances, and sleep patterns. Drivers were considered to be sleepy while driving if they reported a medium or high probability of napping while driving at night, during the daytime, or while stopped in traffic. The statistical analysis used logistic regression models progressively adjusted for age, behavioral variables, sleep duration, and other working conditions. Results: In total, 670 male drivers, with a mean age of 41.9 (±11.1) years, were enrolled. The prevalence of sleepiness while driving was 31.5%. After model adjustments, the following working conditions were associated with sleepiness while driving: Distance from the last shipment of more than 1,000 km (odds ratio [OR] = 1.54; 95% confidence interval [CI], 1.07-2.23) and a formal labor contract with a productivity-based salary (OR = 2.65; 95% CI, 1.86-3.78). Consumption of illicit psychoactive substances (OR = 1.99; 95% CI, 1.14-3.47) was also associated with sleepiness while driving. Conclusions: Distance traveled and a formal labor contract with productivity-based earnings were the working conditions associated with sleepiness while driving, regardless of other working or behavioral characteristics, age, consumption of illicit psychoactive substances, and sleep duration.

Cuidado farmacêutico em diabetes mellitus tipo 2: um desafio a ser enfrentado / Pharmaceutical care in type 2 diabetes: a challenge to be faced

Dentre as doenças crônicas não transmissíveis mais prevalentes no panorama atual, o diabetes mellitus desponta não somente como doença de maneira isolada, mas também como resultado das suas inúmeras complicações. É caracterizado por uma síndrome de etiologia múltipla, com hiperglicemia persistente em decorrência dos defeitos na produção de insulina ou na sua ação sobre as células. Objetivo: Analisar o impacto do Cuidado Farmacêutico no controle glicêmico de usuários de Unidades de Saúde com diagnóstico de diabetes mellitus tipo 2 (DM2) em um município de pequeno porte do Paraná. Método: Estudo quantitativo realizado entre setembro de 2021 à março de 2022, que analisou desfechos clínicos como glicemia de jejum, hemoglobina glicada (HbA1c) e microalbuminúria em pacientes com diagnóstico de DM2. Resultados: Dos 17 participantes, 11 eram do sexo feminino (64,7%), com média de idade de 60,4 anos (dp ± 10,7), variando entre 41 e 79 anos. Ocorreu uma discreta redução na média dos resultados de HbA1c depois do Cuidado Farmacêutico, passando de 9,9% no início do estudo para 9,2% ao final dele. Entretanto, houve uma melhora substancial nos níveis de HbA1c em 58,8% dos pacientes, observando-se 53% de redução para um dos indivíduos acompanhados. Conclusões: Bons resultados foram evidenciados durante o processo de Cuidado Farmacêutico em pacientes com DM2, onde verificou-se a diminuição clinicamente importante dos índices de HbA1c, o que influencia na redução das complicações decorrentes da doença

Among the most prevalent non-communicable chronic diseases in the current scenario, diabetes emerges not only as a disease in isolation but also as result of the countless complications. It is characterized by a syndrome of multiple etiologies, with persistent hyperglycemia due to defects in insulin production or in its action on cells. Objetctive: Analyze the impact of Pharmaceutical Care on the glycemic control of users of basic health units diagnosed with type 2 diabetes (DM2) in a small city in Parana. Method: Quantitative study carried out between September 2021 and march 2022, that analyzed clinical outcomes such as fasting blood glucose, glycated hemoglobin (HbA1c) and microalbuminuria in patients diagnosed with DM2. Results: Of the 17 participants, 11 were female (64,7%), with a mean age od 60.4 years (sd ± 10.7), ranging between 41 and 79 years. There was a slight reduction in mean HbA1c results after Pharmaceutical Care, from 9.9% to 9.2% at the end of the study. However, there was a substantial improvement in these values in 58.8% of the patients, reaching a 53% reduction for one of the followed individuals. Conclusions: Good results were evidenced during the Pharmaceutical Care process in user with DM2, with a significant decrease in glycated hemoglobin levels, which influences the reduction of complications resulting from the disease