RESUMO
Morbidity and mortality in Down syndrome (DS) are mainly related to congenital heart defects (CHDs). While CHDs with high prevalence in DS (typical CHDs), such as endocardial cushion defects, have been extensively described, little is known about the impact of less common CHDs (atypical CHDs), such as aortic coarctation and univentricular hearts. In our single-center study, we analyzed, in observational, retrospective manner, data regarding cardiac features, surgical management, and outcomes of a cohort of DS patients. Literature review was performed to investigate previously reported studies on atypical CHDs in DS. Patients with CHDs were subclassified as having typical or atypical CHDs. Statistical analysis was performed for comparison between the groups. The study population encompassed 859 DS patients, 72.2% with CHDs, of which 4.7% were atypical. Statistical analysis showed a significant excess in multiple surgeries, all-cause mortality and cardiac mortality in patients with atypical CHDs (p = .0067, p = .0038, p = .0001, respectively). According to the Kaplan-Meier method, survival at 10 and 40 years was significantly higher in typical CHDs (99 and 98% vs. 91 and 84%, log rank <0.05). Among atypical CHDs, it seems that particularly multiple complex defects in univentricular physiology associate with a worse outcome. This may be due to the surgical difficulty in managing univentricular hearts with multiple defects concurring to the clinical picture or to the severity of associated defects themselves. Further studies need to address this specific issue, also considering the higher pulmonary pressures, infective complications, and potential comorbidities in DS patients.
Assuntos
Síndrome de Down/mortalidade , Comunicação Atrioventricular/mortalidade , Cardiopatias Congênitas/mortalidade , Comunicação Interatrial/mortalidade , Coartação Aórtica , Criança , Pré-Escolar , Síndrome de Down/complicações , Síndrome de Down/patologia , Comunicação Atrioventricular/complicações , Comunicação Atrioventricular/patologia , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/patologia , Comunicação Interatrial/complicações , Comunicação Interatrial/patologia , Humanos , Masculino , Morbidade , Estudos Retrospectivos , Fatores de RiscoRESUMO
Currently, about one in five workers is employed in night shift work in Europe. Shift work including nighttime hours is essential in several activities, especially the healthcare sector. Importantly, night working may be associated with the occurrence of sleep disorders or work-related stress, both potentially augmenting the risk of errors and accidents at work. This study aims to examine the presence of neurobehavioral alterations that can be a consequence of shift working and concurrent misalignment of the sleep times and circadian rhythms. Nurses (n = 102) employed at a University Hospital located in North-Eastern Sicily, Italy, voluntarily participated in this pilot study. During medical surveillance, morning and evening salivary samples were collected, and seven psychodiagnostics questionnaires were administered to all the subjects. On one hand, the salivary levels of stress-related biomarkers (cortisol and alpha-amylase) and a circadian biomarker (melatonin) were evaluated. On the other hand, several neurobehavioral features were assessed, including depression, anxiety, work-related, and sleep issues. Interestingly, a positive relationship between salivary morning cortisol and depression scale, as well as a negative relationship between salivary morning alpha-amylase and work ability scale, were observed. Based on these results, the integration of subjective questionnaire outcomes and objective salivary biomarker quantification can help to identify workers with increased susceptibility to developing neurobehavioral alterations. This approach may contribute to ameliorating preventive strategies towards sensitive categories, such as nurses working rotation shifts.
Assuntos
Hidrocortisona , Enfermeiras e Enfermeiros , Humanos , Projetos Piloto , Rotação , Sono , Ritmo Circadiano , Biomarcadores , alfa-Amilases , Sicília , Tolerância ao Trabalho ProgramadoRESUMO
The sudden burst of the COVID-19 pandemic has changed the work environment in favor of remote working, affecting the perception of work quality, satisfaction and performance. This crisis has also influenced workers' mood, sleep quality and general perception of everyday life. Our main purpose in this study was to give empirical contributions about home office workers experiencing remote working during the pandemic by assessing mood spectrum variations, sleep disturbances and the general impact of pandemic in everyday life. This cross-sectional study was performed between November and December 2020 through an online questionnaire. Participants were office workers performing remote work from workstations settled at home. The questionnaire investigated sociodemographic characteristics, health factors, perception of remote working, mood spectrum, sleep quality and pandemic context perception. The sample consisted of 94 respondents: 63 women and 31 men; the mean age was 50.4 years. Study population showed great satisfaction for remote working performance and online services for video connections. Only one third of the participants reported higher levels of irritability and loneliness and 16% of women complained of nightmares. Most of participants stated that the pandemic importantly affected daily life (85.1%). Half of female subjects with children <18 years stated that children's age influenced their work performance. Since the pandemic is still an ongoing issue, the lesson learnt is that local government actions are needed to assist home office workers through tailored programs to support families. Given the central role of women in childcare, female workers would mainly benefit from social support accordingly to their parental tasks and remote work organization.