Blood and CSF anti-neuronal antibodies testing in psychotic syndromes: a retrospective analysis from a tertiary psychiatric hospital.

A Consensus of Psychoimmunology Experts (Pollak et al., 2019) established a set of red flags and proposed diagnostic criteria for psychosis of autoimmune origin (AIP). Previous studies on AIP are limited by the scarcity of CSF analysis, preventing the valorization of blood anti-neuronal antibodies (Ab). The aims of this study are to determine the relative frequency and characterize AIP in a cohort of psychotic patients that underwent CSF workup. This work is a retrospective study in a tertiary psychiatric hospital. Clinical and paraclinical data were collected from medical records, and patients were classified according to Pollak et al. (2019) criteria. From 68 patients, ten (14.7%) had positive anti-neuronal antibodies (Ab): n = 5 in CSF and blood (n = 4 anti-NMDAr, n = 1 -GAD65), and n = 5 in blood only (n = 1 anti-GABAb, n = 1 -GAD65, n = 1 -SOX1, n = 1 -NMDAr, n = 1 -zic4). After 5- (2-10)-year follow-up, n = 6/68 (8.8%) had AIP diagnosis in context of autoimmune encephalitis (AE), and the remaining (n = 4/10, blood-only Ab) alternative diagnoses (n = 2 dementia, n = 1 schizophrenia, n = 1 intellectual disability). Ten of the 13 patients that fulfilled criteria for possible AIP were mimics, and only three AE had criteria for probable AIP. All AIP developed neurological manifestations (mostly cognitive dysfunction); EEG was usually abnormal (66.7%), and all had normal MRI. We found statistically significant associations between AIP/AE and systemic autoimmune disease, presentation with seizures and EEG abnormalities. All AE developed neurological symptoms alongside psychosis. Ab positivity occurred predominantly in AE but also in other neuropsychiatric disorders. Clinical suspicion based on the knowledge of the described presentations of established Ab is crucial in the psychotic patient approach.

Quality of life and work engagement among nursing staff at the start of the COVID-19 pandemic. / Qualidade de vida e engajamento no trabalho em profissionais de enfermagem no início da pandemia de COVID-19.

This article investigates the correlation between work engagement and work-related quality of life among nursing staff at a public hospital in São Paulo State, at the onset of the COVID-19 pandemic. A descriptive, correlational, cross-sectional study of nursing personnel was conducted from December 2020 to January 2021, using the Brazilian versions of the Work & Well-being Survey (Utrecht Work Engagement Scale - UWES) and the Work-related Quality of Life (WRQoL) scale, following Walton's model. Nursing staffs returned a strong positive correlation (r≥0.70) between the social integration domain of the WRQoL and the vigour dimension of the UWES (r=0.88; p=<0.001); a moderate positive correlation (r≥0.40≤0.69) between working conditions (WRQOL) and the vigour (r=0.40; p<0.001), dedication (r=0.40; p<0.001) and overall score (r=0.41; p<0.001) dimensions of the UWES. Correlations were positive and weak (r≤0.39) for the other WRQoL domains and the UWES dimensions. It was concluded that personnel with satisfactory levels of quality of life tend to show higher levels of engagement at work. At the onset of the COVID-19 pandemic, nursing professionals were strongly engaged and satisfied with their work-related quality of life.

O artigo investiga a correlação entre engajamento e qualidade de vida no trabalho dos profissionais de enfermagem de um hospital público do interior do estado de São Paulo, no início da pandemia de COVID-19. Estudo transversal, descritivo e correlacional, com profissionais de enfermagem, realizado entre dezembro de 2020 e janeiro de 2021. Foram utilizadas as versões brasileiras da Utrecht Work Engagement Scale (UWES) e da Escala de Avaliação da Qualidade de Vida no Trabalho (QVT), segundo modelo de Walton. Os profissionais de enfermagem apresentaram correlação forte e positiva (r≥0.70) entre o domínio integração social da QVT e a dimensão vigor da UWES (r=0,88; p=<0,001); correlação positiva moderada (r≥0.40≤0.69) entre as condições de trabalho (QVT) e as dimensões vigor (r=0,40; p=<0,001), dedicação (r=0,40; p=<0,001) e escore geral (r=0,41; p=<0,001) da UWES. As correlações foram positivas e fracas (r≤0.39) para os demais domínios da QVT e as dimensões da UWES. Concluiu-se que os profissionais com níveis satisfatórios de qualidade de vida tendem a ter níveis mais altos de engajamento no trabalho. No início da pandemia de COVID-19, os profissionais de enfermagem estavam fortemente engajados e satisfeitos com sua qualidade de vida no trabalho.

Qualidade de vida e engajamento no trabalho em profissionais de enfermagem no início da pandemia de COVID-19 / Quality of life and work engagement among nursing staff at the start of the COVID-19 pandemic

Resumo O artigo investiga a correlação entre engajamento e qualidade de vida no trabalho dos profissionais de enfermagem de um hospital público do interior do estado de São Paulo, no início da pandemia de COVID-19. Estudo transversal, descritivo e correlacional, com profissionais de enfermagem, realizado entre dezembro de 2020 e janeiro de 2021. Foram utilizadas as versões brasileiras da Utrecht Work Engagement Scale (UWES) e da Escala de Avaliação da Qualidade de Vida no Trabalho (QVT), segundo modelo de Walton. Os profissionais de enfermagem apresentaram correlação forte e positiva (r≥0.70) entre o domínio integração social da QVT e a dimensão vigor da UWES (r=0,88; p=<0,001); correlação positiva moderada (r≥0.40≤0.69) entre as condições de trabalho (QVT) e as dimensões vigor (r=0,40; p=<0,001), dedicação (r=0,40; p=<0,001) e escore geral (r=0,41; p=<0,001) da UWES. As correlações foram positivas e fracas (r≤0.39) para os demais domínios da QVT e as dimensões da UWES. Concluiu-se que os profissionais com níveis satisfatórios de qualidade de vida tendem a ter níveis mais altos de engajamento no trabalho. No início da pandemia de COVID-19, os profissionais de enfermagem estavam fortemente engajados e satisfeitos com sua qualidade de vida no trabalho.

Abstract This article investigates the correlation between work engagement and work-related quality of life among nursing staff at a public hospital in São Paulo State, at the onset of the COVID-19 pandemic. A descriptive, correlational, cross-sectional study of nursing personnel was conducted from December 2020 to January 2021, using the Brazilian versions of the Work & Well-being Survey (Utrecht Work Engagement Scale - UWES) and the Work-related Quality of Life (WRQoL) scale, following Walton's model. Nursing staffs returned a strong positive correlation (r≥0.70) between the social integration domain of the WRQoL and the vigour dimension of the UWES (r=0.88; p=<0.001); a moderate positive correlation (r≥0.40≤0.69) between working conditions (WRQOL) and the vigour (r=0.40; p<0.001), dedication (r=0.40; p<0.001) and overall score (r=0.41; p<0.001) dimensions of the UWES. Correlations were positive and weak (r≤0.39) for the other WRQoL domains and the UWES dimensions. It was concluded that personnel with satisfactory levels of quality of life tend to show higher levels of engagement at work. At the onset of the COVID-19 pandemic, nursing professionals were strongly engaged and satisfied with their work-related quality of life.

Premature Ejaculation after Lithium Treatment in a Patient with Bipolar Disorder.

Lithium has proven its efficacy in treating bipolar disorder. Severe side effects caused by lithium, including renal and endocrine outcomes, have already been amply documented. The impact of lithium on sexual function, however, is less well known. A 33-year-old man, with no past medical history, diagnosed with bipolar disorder, developed premature ejaculation after short-term use of lithium. The dose of lithium was reduced, leading to a rapid clinical resolution. Retrospectively, lithium-induced premature ejaculation was deemed the most likely diagnosis. Premature ejaculation is a rare side effect of lithium. Changing the time of medication administration and lowering dose could be considered as alternatives. Given lithium's pharmacological profile, it is likely that the pathophysiologic mechanism behind premature ejaculation is altered levels or altered serotonin receptor sensitivity in the ejaculatory modulating centers of the central nervous system. Given the reluctance to spontaneously report sexual adverse effects, clinicians should be aware of this possible side effect.

Prescribing stigma in mental disorders: A comparative study of Portuguese psychiatrists and general practitioners.

BACKGROUND: Physicians, including psychiatrists and general practitioners (GPs), have been reported as essential sources of stigma towards people diagnosed with a mental disorder (PDMDs), which constitutes an important barrier to recovery and is associated with poorer clinical outcomes. Therefore, psychiatrists and GPs are key populations where it is crucial to examine stigma, improve attitudes and reduce discrimination towards psychiatric patients. AIMS: This study is the first to explore mental health-related stigma among Portuguese psychiatrists and GPs, examining the differences between these two specialities and assessing whether sociodemographic and professional variables are associated with stigma. METHOD: A cross-sectional study was performed between June 2018 and August 2019. A consecutive sample of 55 Psychiatrists and 67 GPs working in Porto (Portugal) filled a 25-item self-report questionnaire to assess their attitudes towards PDMDs in clinical practice. The instrument was designed by the authors, based on previous mental health-related stigma studies and validated scales. The questionnaire includes 12 stigma dimensions (Autonomy, Coercion, Incompetence, Dangerousness, Permanence, Pity, Responsibility, Segregation, Labelling, Diagnostic Overshadowing, Shame and Parental Incompetence), and its total score was used to measure Overall Stigma (OS). Sample characteristics were examined using descriptive statistics, and the factors affecting stigma were assessed through regression analysis. RESULTS: GPs exhibit significantly higher OS levels than psychiatrists, and present higher scores in the dimensions of dangerousness, parental incompetence, diagnostic overshadowing and responsibility. Besides medical speciality, several other sociodemographic variables were associated with sigma, including age, gender, having a friend with a mental disorder, professional category, agreement that Psychiatry diverges from core medicine and physician's interest in mental health topics. CONCLUSIONS: Our data suggest that both psychiatrists and GPs hold some degree of stigmatizing attitudes towards PDMDs. Overall, these results bring new light to stigma research, and provide information to tailor anti-stigma interventions to Portuguese psychiatrists and GPs.

Effect of shock wave therapy associated with aerobic exercise on cellulite: A randomized controlled trial.

BACKGROUND: Cellulite is a multifactor and controversial condition. Several methods have been explored to reduce it, not always with favorable results. Shock Wave Therapy has been shown to be effective, but the results of its association with an Aerobic Exercise Program are unknown. AIMS: To verify whether Shock Wave Therapy in association with an Aerobic Exercise Program reduces the degree of severity of Cellulite in the gluteal region and in the ⅓ of the proximal posterior of the thigh. METHODS: Forty-five healthy women, aged from 18 to 32, randomly assigned, considering the severity degree in the Cellulite Severity Scale and the level of physical activity, in three groups: two experimental and one control group. The control group performed the evaluations. The experimental group 1 performed an Aerobic Exercise Program, and the experimental group 2 associated this program with a Radial Shock Wave Therapy protocol. The experimental groups completed six interventions within 3 weeks. In addition, the degree of severity in the Cellulite Severity Scale, height, body composition, skin temperature, and subcutaneous adipose tissue thickness were assessed. One-way ANOVA test and Kruskal-Wallis were used to obtain the results, with level of significance of 0.05. RESULTS: Forty-two women completed the study. There was a significant reduction in the severity of Cellulite between experimental group 2 and group 1 (P = 0.032), and from group 2 to the control group (P = 0.042). CONCLUSION: The association of Shock Wave Therapy and Aerobic Exercise was shown to be effective in reducing the severity of cellulite.

Attachment Style and Insight in Schizophrenia: a Cross-Sectional Study.

Attachment theory provides a model for understanding impairments in social and interpersonal functioning. Schizophrenia is a neuropsychiatry disorder frequently associated with compromised social functioning and limited social support networks. However, the relationship between attachment style and psychopathology dimensions, including insight, isn't fully understood To determine whether there is a relationship between the attachment style and markers for severity of schizophrenia and insight. We conducted a cross-sectional study of 41 patients with schizophrenia and 34 patients with non-psychotic disorders used as a control group. Patients were assessed using semi-structured diagnostic interviews and self-reporting questionnaires, including Adult Attachment Scale-Revised. The schizophrenia group was also given the Positive and Negative Syndrome Scale and the Markova and Berrios Insight Scale. Insecure attachment was overrepresented in the schizophrenic group, and this difference was mainly accounted for lower levels of dependence, representing a moderate effect size (Cohen's d = 0.32). In the schizophrenia group, the closeness and the dependence subscale were negatively correlated with psychopathology severity. Using a multiple regression analysis, the insight was predicted by attachment anxiety, accounting for 20% of the total variance (R2 = 0.199, p <0.05). Our data confirm previous evidence that insecure attachment is associated with schizophrenia and suggest that the less comfortable the patient is with closeness and intimacy the greater the severity of symptoms. Furthermore, our findings indicate that higher separation anxiety might predict a better insight.

Hydrophobic nanoprecipitates formed by benzoylphenylureas and ß-cyclodextrin inclusion compounds: synthesis, characterization and toxicity against aedes aegypti larvae.

The aim of this work was to synthesize and characterize the inclusion compounds formed by the complexation of ß-cyclodextrin (ßCD) with insecticides from the class of benzoylphenylureas (BPUs), named novaluron (NOV) and diflubenzuron (DIF), beyond evaluate their larvicidal activity against Aedes aegypti larvae. Solid state characterization by FTIR showed changes in the main peaks of BPUs and ßCD, suggesting the formation of inclusion compounds in solid phase. DTA and TGA thermal analysis showed changes in temperatures of BPUs decomposition as result of molecular interactions. 1H NMR experiments allowed to observe the occurrence of interactions in solution through changes in chemical shifts of BPUs aromatic hydrogens. However, the presence of H-H intermolecular correlations in 2D ROESY was found only for the DIF/ßCD complex, suggesting different topology for each complex. Such hypothesis was corroborated by thermodynamic analysis using ITC, which showed different profile of titration curves, beyond endothermic and exothermic interactions for NOV/ßCD and DIF/ßCD complexes, respectively. DLS titrations of BPUs or BPUs/ßCD DMSO solutions in aqueous solution demonstrated that the spontaneously formed hydrophobic nanoprecipitates (HNPs) have different profile of sizes depending on the BPU/ßCD system, corroborating also with the hypothesis about the existence of different topologies for each complex. Finally, the HNPs of inclusion compounds showed to be more efficient than free BPUs, allowing proposing a new insecticide formulation.

Comunicação eletrônica entre profissionais de saúde na assistência ao paciente: revisão integrativa / Electronic communication between health professionals in patient assistance: integrative review / Comunicación electrónica entre profisionales de salud em la asistencia al paciente: revisión integrativa

Objetivo: Analisar a literatura científica a respeito da comunicação por meios eletrônicos entre profissionais de saúde. Método: Revisão integrativa da literatura, realizada nas bases de dados e/ou portais PubMed, Biblioteca Virtual em Saúde e Cochrane, até agosto de 2018, com descritores combinados, que respondem à pergunta norteadora: "Como ocorre a comunicação eletrônica entre os profissionais de saúde na assistência ao paciente? ”. Resultados: Seis artigos foram incluídos, publicados de 2011 a 2016, no idioma Inglês. Os recursos foram smartphone, pager e tablet. Os aplicativos utilizados foram WhatsApp, Medigram e Serviço de Mensagens Curtas (SMS). Agilidade, facilidade de uso e auxílio na tomada de decisão foram as vantagens encontradas no uso desse recurso na comunicação dos profissionais; dentre as desvantagens estão ausência de privacidade e de confidencialidade das informações, interrupções na assistência e inabilidade no uso do recurso tecnológico. Conclusão: O uso de aplicativos para troca de mensagens e comunicação interdisciplinar de fato proporciona agilidade na comunicação, mas a confidencialidade desses dados ainda é uma questão a ser tratada. Assim, cabe ao enfermeiro conduzir a comunicação com os demais profissionais, preservando a privacidade do paciente.

Purpose: To analyze scientific literature regarding the communication via electronic means between health professionals. Method: Integrative revision of the literature carried through databases and/or portals PubMed, Virtual Health Library and Cochrane, until August 2018, with combined describers, who answer to the leading question: "How does the electronic communication between health professionals in patient assistance occur?". Results: Six articles were included, published from 2011 to 2016 in the English language. Features were smartphone, pager and tablet. The applications used were WhatsApp, Medigram and Short Message Service (SMS). Agility, ease of use and support in decision-making were the advantages found in the use of this resource in the communication of professionals; among the disadvantages are lack of privacy and confidentiality of information, interruptions in assistance and inability to use the technological resource. Conclusion: The use of applications for messaging and interdisciplinary communication does indeed provide agility in communication, but the confidentiality of such data is still an issue to be addressed. Thus, it is up to the nurse to conduct communication with the other professionals, preserving the patient's privacy

Objetivo: Analizar la literatura científica acerca de la comunicación por medios electrónicos entre profesionales de salud. Método: Revisión integrativa de la literatura, realizada en las bases de datos y/o portales PubMed, Biblioteca Virtual em Salud y Cochrane, hasta agosto de 2018, con descriptores combinados, que responden a la pregunta orientadora: "¿Cómo ocurre la comunicación electrónica entre los profesionales de salud en la asistencia al paciente?". Resultados: Seis artículos fueron incluidos, publicados de 2011 a 2016, en el idioma Inglés. Los recursos fueron teléfono inteligente,pager y tablet. Las aplicaciones utilizadas fueron Whatsapp, Medigram y Servicio de mensajes cortos (SMS). Agilidad, facilidad de uso y ayuda em la tomada de decisión fueron las ventajas encontradas en el uso de ese recurso en la comunicación de los profesionales; entre las desventajas están la ausencia de privacidad y de confidencialidad de las informaciones, interrupciones em la asistencia e inhabilidad en el uso del recurso tecnológico. Conclusión: El uso de aplicaciones para el intercambio de mensajes y la comunicación interdisciplinaria de hecho proporciona agilidad en la comunicación, per la confidencialidad de estos datos sigue siendo una cuestión a tratar. Así, corresponde al enfermero conducir la comunicación con os demás profesionales, preservando la privacidad del paciente.

Workers' perception of hazards on recycling sorting facilities in São Paulo, Brazil.

The paper discusses views, perceptions, experiences, knowledge and behaviors related to occupational risks among recycling workers. Data collection involved field observation and two focus groups in each site. Narratives were recorded, transcribed, and analyzed for themes. Findings are presented according to the following topics: economic and environmental value of recycling; aspects of employment in the cooperative system; occupational hazards; and suggestions of improvements. Municipal programs of selective collection, as implemented in most Brazilian municipalities, still need improvements to achieve their goals and objectives. We learned that organizing recycling workers in cooperatives, despite its broad acceptance as a replacement to informal garbage collection in streets and landfills, only brought small progress regarding the safety and quality of life of cooperative workers. Recycling workers noticed the existence of workplace hazards, but seemed resigned to the situation, considered them as part of the job and did not communicate their needs to supervisors. They ignored the existence of some measures to prevent hazards and sometimes even created work practices and alternatives that endangered their own health.

Workers' perception of hazards on recycling sorting facilities in São Paulo, Brazil / Percepção dos trabalhadores quanto aos perigos em centrais de triagem de recicláveis em São Paulo, Brasil

Abstract The paper discusses views, perceptions, experiences, knowledge and behaviors related to occupational risks among recycling workers. Data collection involved field observation and two focus groups in each site. Narratives were recorded, transcribed, and analyzed for themes. Findings are presented according to the following topics: economic and environmental value of recycling; aspects of employment in the cooperative system; occupational hazards; and suggestions of improvements. Municipal programs of selective collection, as implemented in most Brazilian municipalities, still need improvements to achieve their goals and objectives. We learned that organizing recycling workers in cooperatives, despite its broad acceptance as a replacement to informal garbage collection in streets and landfills, only brought small progress regarding the safety and quality of life of cooperative workers. Recycling workers noticed the existence of workplace hazards, but seemed resigned to the situation, considered them as part of the job and did not communicate their needs to supervisors. They ignored the existence of some measures to prevent hazards and sometimes even created work practices and alternatives that endangered their own health.

Resumo O artigo discute pontos de vista, percepções, experiências, conhecimentos e comportamentos relacionados aos riscos ocupacionais entre os trabalhadores de reciclagem. Coleta de dados envolveu observação de campo e dois grupos focais em cada unidade. Narrativas foram gravadas, transcritas e analisadas por temas. Resultados são apresentados de acordo com os seguintes tópicos: valor econômico e ambiental da reciclagem; aspectos do sistema cooperativista; riscos ocupacionais e sugestões de melhorias. Programas municipais de coleta seletiva, tal como implantados na maioria dos municípios brasileiros, ainda precisam de melhorias para atingir suas metas e objetivos. Aprendemos que a organização de trabalhadores da reciclagem em cooperativas, apesar de sua ampla aceitação como um substituto para a coleta de lixo informal nas ruas e aterros, trouxe pouco progresso em relação à segurança e qualidade de vida dos cooperados. Os trabalhadores notaram a existência de riscos no local de trabalho, mas parecem resignados com a situação, consideram como parte do trabalho e não comunicam as suas necessidades aos supervisores. Eles ignoraram a existência de algumas medidas para evitar riscos e, por vezes, até criam práticas de trabalho e alternativas que colocam em perigo a própria saúde.

Psicoterapia de Grupo de inspiração fenomenológico-existencial em pacientes esquizofrênicos / Group psychotherapy of phenomenological-existential inspiration in schizophrenic patients

A psicoterapia existencial é uma abordagem filosoficamente informada à psicoterapia. Surgiu como um esforço de convergir conhecimentos da fenomenologia e do movimento existencial com a prática terapêutica. Esta psicoterapia é um processo colaborativo e integrativo que privilegia a confrontação com os existenciais e a compreensão empática da experiência subjetiva do paciente, promovendo o desenvolvimento de um self autêntico. Previamente descrita por alguns autores como insegurança ontológica e perda do contato vital com a realidade, a esquizofrenia acarreta frequentemente dificuldades acrescidas em diversas áreas da vida e isolamento social. O objetivo deste artigo é discutir a aplicabilidade da psicoterapia de grupo de inspiração fenomenológico-existencial na esquizofrenia. Primeiro, revemos a literatura existente acerca da psicoterapia de grupo na esquizofrenia, introduzindo a terapia existencial e enfatizando áreas de convergência e de diferença. Depois, descrevemos a experiência de um grupo psicoterapêutico de pacientes com esquizofrenia. Numa perspetiva conceptual, a terapia de inspiração fenomenológico-existencial pode fundar qualquer intervenção terapêutica na esquizofrenia. Durante as sessões de grupo os pacientes foram encorajados a explorar descritivamente o seu mundo vivido e a reconhecer as suas liberdades e responsabilidades. Foi de grande valor a abordagem das preocupações existenciais, frequentemente negligenciadas em outros modelos psicoterapêuticos. Esta abordagem não pretende substituir o tratamento padrão, reconhecendo que uma mudança dramática de paradigma podia significar uma visão despatologizada da esquizofrenia. Em vez disso, argumentamos pela assimilação. E numa altura em que os terapeutas se encontram focados no alívio sintomático imediato e sobrecarregados com resultados funcionais esta assimilação pode ter particular importância.(AU)

Existential Psychotherapy is a philosophically informed approach to psychotherapy. It began as an effort to merge valuable insights coming from phenomenology and the existential movement with the therapeutic practice. This psychotherapy is a collaborative and integrative process which privileges the confrontation with the givens of existence and the empathic understanding of the patient's subjective experience, promoting the development of an authentic self. Previously described by some authors as ontological insecurity and loss of vital contact with reality, schizophrenia often leads to increased difficulties in diverse areas of daily life and to social isolation. The aim of this article is to discuss the feasibility of group psychotherapy of phenomenologicalexistential inspiration in schizophrenia. First, we review the published literature of group psychotherapy in schizophrenia, introducing existential therapy and highlighting areas of commonality and difference. Then we describe the experience of a psychotherapeutic group of patients with schizophrenia. From a conceptual perspective, phenomenological-existential inspired therapy could provide a theoretical foundation for any therapeutic intervention in schizophrenia. During group sessions, patients were encouraged to descriptively explore their lived-worlds and to acknowledge their freedom and responsibility. It was highly valuable to address existential concerns, which are often neglected in other psychotherapeutic models. This approach is not meant to replace the current treatment standards, recognizing that a dramatic shift could bring a de-pathologizing view of schizophrenia. Instead, we argue for assimilation. When therapists are becoming increasingly preoccupied with immediate symptom relief and burdened with functional outcomes, this assimilation may be of particular significance.(AU)

Effects of a cognitive training program and sleep hygiene for executive functions and sleep quality in healthy elderly.

INTRODUCTION: The aging process causes changes in the sleep-wake cycle and cognition, especially executive functions. Interventions are required to minimize the impact of the losses caused by the aging process. OBJECTIVE: To evaluate the effects of a cognitive training program and psychoeducation on sleep hygiene techniques for executive functions and sleep quality in healthy elderly. METHODS: The participants were 41 healthy elderly randomized into four groups ([CG] control group, cognitive training group [CTG], sleep hygiene group [SHG] and cognitive training and hygiene group [THG]). The study was conducted in three stages:1st - assessment of cognition and sleep;2nd - specific intervention for each group;3rd - post-intervention assessment. RESULTS: The results showed that the CTG had significant improvements in cognitive flexibility tasks, planning, verbal fluency and episodic memory, gains in sleep quality and decreased excessive daytime sleepiness. The SHG also had improved sleep quality, excessive daytime sleepiness and significant improvements in insights, planning, attention and episodic memory. The THG had significant gains in cognitive flexibility, problem solving, verbal fluency, attention and episodic memory. CONCLUSION: Cognitive training and sleep hygiene interventions were useful strategies for improving cognitive performance and sleep quality of healthy elderly, but there was no evidence that sessions combining cognitive training and psychoeducation on sleep hygiene enhanced the gains provided by these interventions applied individually.

INTRODUÇÃO: O processo de envelhecimento provoca alterações no padrão de vigília sono dos idosos e na cognição, em especial no funcionamento executivo, sendo necessárias intervenções que visem minimizar os impactos das perdas ocorridas pelo processo de envelhecimento. OBJETIVO: Avaliar o efeito de um programa de treino cognitivo e das técnicas de higiene do sono para as funções executivas e qualidade de sono em idosos saudáveis. MÉTODOS: Participaram da pesquisa 41 idosos saudáveis, divididos aleatoriamente em quatro grupos distintos (grupo controle [GC], grupo treino cognitivo [GTC], grupo higiene do sono [GHS] e grupo treino + higiene [GTH]). A pesquisa aconteceu em três etapas:1ª ­ avaliação inicial da cognição e do sono;2ª ­ intervenção específica destinada a cada grupo; e3ª ­ reavaliação pós-intervenção. RESULTADOS: Os resultados mostraram que o GTC apresentou melhora significativa em tarefas de flexibilidade cognitiva, planejamento, fluência verbal, memória episódica, qualidade de sono e diminuição da sonolência excessiva diurna. O GHS melhorou a qualidade do sono, sonolência diurna e teve melhoras significativas em capacidade de insights, planejamento, atenção e memória episódica. O GTH teve ganhos significativos na flexibilidade cognitiva, na resolução de problemas, na fluência verbal, na atenção e na memória episódica. CONCLUSÃO: Intervenções com treino cognitivo e higiene do sono são estratégias úteis na melhora do desempenho cognitivo e da qualidade de sono de idosos saudáveis, entretanto não houve evidências de que a intervenção com sessões combinando o treino cognitivo e psicoeducação da higiene do sono potencializem os ganhos proporcionados por essas intervenções isoladamente.

Distressing Visual Hallucinations after Treatment with Trazodone.

Trazodone, a second-generation atypical antidepressant, is increasingly being used off-label, in the treatment of insomnia. Although generally well tolerated, trazodone treatment can be associated with some complications. We describe a case of a 60-year-old man who received trazodone for primary insomnia. He returned, to the emergency department, two days later with distressing visual hallucinations, which prompted inpatient treatment. Trazodone was discontinued, leading to a complete resolution of his visual hallucinations, and he was treated with mirtazapine for 6 months. There has been no relapse in a follow-up period of two years. Patients presenting with visual hallucinations without significant psychiatry history can be a challenging situation. We highlight the importance of careful anamnesis with an accurate medication history. Given the widespread use of trazodone, clinicians should be aware of this possible side effect.

Effects of a cognitive training program and sleep hygiene for executive functions and sleep quality in healthy elderly / Efeitos de um programa de treino cognitivo e da higiene do sono para as funções executivas e para a qualidade de sono em idosos saudáveis

ABSTRACT Introduction: The aging process causes changes in the sleep-wake cycle and cognition, especially executive functions. Interventions are required to minimize the impact of the losses caused by the aging process. Objective: To evaluate the effects of a cognitive training program and psychoeducation on sleep hygiene techniques for executive functions and sleep quality in healthy elderly. Methods: The participants were 41 healthy elderly randomized into four groups ([CG] control group, cognitive training group [CTG], sleep hygiene group [SHG] and cognitive training and hygiene group [THG]). The study was conducted in three stages: 1st - assessment of cognition and sleep; 2nd - specific intervention for each group; 3rd - post-intervention assessment. Results: The results showed that the CTG had significant improvements in cognitive flexibility tasks, planning, verbal fluency and episodic memory, gains in sleep quality and decreased excessive daytime sleepiness. The SHG also had improved sleep quality, excessive daytime sleepiness and significant improvements in insights, planning, attention and episodic memory. The THG had significant gains in cognitive flexibility, problem solving, verbal fluency, attention and episodic memory. Conclusion: Cognitive training and sleep hygiene interventions were useful strategies for improving cognitive performance and sleep quality of healthy elderly, but there was no evidence that sessions combining cognitive training and psychoeducation on sleep hygiene enhanced the gains provided by these interventions applied individually.

RESUMO Introdução: O processo de envelhecimento provoca alterações no padrão de vigília sono dos idosos e na cognição, em especial no funcionamento executivo, sendo necessárias intervenções que visem minimizar os impactos das perdas ocorridas pelo processo de envelhecimento. Objetivo: Avaliar o efeito de um programa de treino cognitivo e das técnicas de higiene do sono para as funções executivas e qualidade de sono em idosos saudáveis. Métodos: Participaram da pesquisa 41 idosos saudáveis, divididos aleatoriamente em quatro grupos distintos (grupo controle [GC], grupo treino cognitivo [GTC], grupo higiene do sono [GHS] e grupo treino + higiene [GTH]). A pesquisa aconteceu em três etapas: 1ª - avaliação inicial da cognição e do sono; 2ª - intervenção específica destinada a cada grupo; e 3ª - reavaliação pós-intervenção. Resultados: Os resultados mostraram que o GTC apresentou melhora significativa em tarefas de flexibilidade cognitiva, planejamento, fluência verbal, memória episódica, qualidade de sono e diminuição da sonolência excessiva diurna. O GHS melhorou a qualidade do sono, sonolência diurna e teve melhoras significativas em capacidade de insights, planejamento, atenção e memória episódica. O GTH teve ganhos significativos na flexibilidade cognitiva, na resolução de problemas, na fluência verbal, na atenção e na memória episódica. Conclusão: Intervenções com treino cognitivo e higiene do sono são estratégias úteis na melhora do desempenho cognitivo e da qualidade de sono de idosos saudáveis, entretanto não houve evidências de que a intervenção com sessões combinando o treino cognitivo e psicoeducação da higiene do sono potencializem os ganhos proporcionados por essas intervenções isoladamente.

Desomorphine (Krokodil): An overview of its chemistry, pharmacology, metabolism, toxicology and analysis.

BACKGROUND: "Krokodil" or "Crocodile" is an illegal homemade desomorphine drug obtained from chemical reactions of commercial codeine drugs with several other powerful and highly toxic chemical agents increasing its addiction and hallucinogenic effects when compared with other morphine analogues. METHODS: This paper summarizes a complete review about an old drug called desomorphine (Krokodil), presenting its chemistry, pharmacology, metabolism, toxicology and analysis. RESULTS: It is of particular interest and concern because this cheaper injectable semisynthetic opioid drug has been largely used in recent years for recreational purposes in several Eastern European as well as North and South American countries, despite known damage to health that continuous use might induce. These injuries are much stronger and more aggressive than morphine's, infecting and rotting skin and soft tissue to the bone of addicts at the point of injection in less than three years, which, in most cases, evolves to death. On this basis, it is imperative that literature reviews focus on the chemistry, pharmacology, toxicology and analysis of dangerous Krokodil to find strategies for rapid and effective determination to mitigate its adverse effects on addicts and prevent consumption. CONCLUSIONS: It is crucial to know the symptoms and consequences of the use of Krokodil, as well as METHODS: for identification and quantification of desomorphine, contaminants and metabolites, which can help the forensic work of diagnosis and propose actions to control and eradicate this great danger to public health around the world.

Riscos e agravos à saúde do trabalhador em centrais de triagem de materiais recicláveis / Risks and health hazards of workers in recycling sorting centers

Resíduos perigosos estão presentes entre materiais resultantes da coleta diferenciada de recicláveis. Se a organização do trabalho de triagem não for adequadamente gerenciada, podem surgir problemas ambientais e ameaças à saúde e segurança dos trabalhadores. A literatura nacional e internacional aponta inúmeros fatores de risco em centrais de triagem de materiais recicláveis. Os objetivos do estudo são: identificar os fatores de risco ocupacional em duas centrais de triagem do município de São Paulo; quantificar as lesões e doenças ocorridas antes e durante o período do estudo; correlacionar os fatores de risco com essas intercorrências, e propor ações para minimizar os danos à saúde dos trabalhadores. Trata-se de estudo de caso múltiplo, exploratório, com abordagem quantiqualitativa. As etapas metodológicas foram: revisão sistemática na literatura nacional e internacional sobre saúde dos catadores de recicláveis; levantamento exploratório preliminar em cinco cooperativas de diferentes regiões do Município de São Paulo para conhecer a situação e selecionar a amostra; levantamento da percepção do catador quanto à importância ambiental do seu trabalho, características e riscos ocupacionais, por meio de grupos focais; levantamento dos riscos físicos, químicos, biológicos, ergonômicos, psicossomáticos, mecânicos e de acidentes, por meio de observações de campo e entrevistas individuais; avaliação das condições de saúde dos participantes, por meio de anamnese e exame físico individualizado; análise dos resultados por integração de dados. Os resultados mostraram que apesar de algumas melhorias conquistadas pelo sistema de organização cooperativista, falta muito para que seja alcançada a tão almejada sustentabilidade social, econômica e ambiental. Porém, o principal problema diz respeito à segurança desses indivíduos no local de trabalho. As centrais, assim como os lixões, continuam a ser ambientes de trabalho inadequados: precários, perigosos e insalubres. Os níveis de produtividade são baixos, assim como a consequente remuneração. Não possuem capacidade técnica para sustentar o empreendimento tanto no âmbito gerencial, organizacional e operacional. Medidas para a promoção da saúde, prevenção de acidentes e de doenças são pontuais e mínimas. Muitos riscos identificados seriam facilmente corrigíveis, sem acarretar grandes investimentos. Os desfechos deste estudo são importantes para suscitar reflexões, ampliar discussões e poderão contribuir na tomada de decisão em diversas esferas de gestão (saúde, previdência, trabalho e ambiente), assim como servir aos interesses e necessidades dos trabalhadores e da população

Hazardous waste is present among materials resulting from the selective collection of recyclables. If organization of the sorting task is not adequately managed, environmental problems and threats to the workers health and safety may arise. National and international literature points out the presence of several hazard factors in recycling sorting facilities. The objectives of the study are: to identify the occupational risks in two sorting facilities in the city of São Paulo; to quantify the injuries and diseases occurred before and during the study period; to correlate the risk factors with the clinical intercurrences, and to propose actions to minimize the damages to the workers health. This is an exploratory, multiplecase study, with a quantitative-qualitative approach. Methodological steps were: systematic review in national and international literature of the health of waste pickers of recyclable materials; preliminary exploratory survey of the situation in five cooperatives of different regions of the Municipality of São Paulo and selection of the samples; survey of the workers perception about the environmental importance and characteristics of their work, and occupational risks (through Focus Groups); survey of physical, chemical, biological, ergonomic, psychosomatic, mechanical and accident hazards (through field observation and individual interviews); evaluation of health conditions through workers individual anamnesis and physical examination; analysis of results by means of data integration. The results showed that despite some improvements achieved until now by the cooperative organization system, it is a long way to reach the long-awaited social, economic and environmental sustainability. However, the main problem remains about these individuals safety in workplace. Either the sorting plants, as well as the dumps, continue to be inadequate work environments: precarious, dangerous and unhealthy. The levels of productivity are low, as well as the consequent remuneration. They do not have technical capacity to support the enterprise in the managerial, organizational and operational scope. Measures to promote health and to prevent accidents and diseases are punctual and minimal. Many of the identified risks would be easily correctable without major investment. The outcomes of this study could be important to stimulate reflection, broaden discussions and contribute to decision-making in various spheres of management (health, welfare, work and environment), as well as serving to the interests and needs of workers and the entire population

Solid waste management in primary healthcare centers: application of a facilitation tool.

OBJECTIVES: to propose a tool to facilitate diagnosis, formulation and evaluation of the Waste Management Plan in Primary Healthcare Centers and to present the results of the application in four selected units. METHOD: descriptive research, covering the stages of formulation /application of the proposed instrument and the evaluation of waste management performance at the units. RESULTS: the tool consists in five forms; specific indicators of waste generation for outpatients healthcare units were proposed, and performance indicators that give scores for compliance with current legislation. In the studied units it is generated common waste (52-60%), infectious-sharps (31-42%) and recyclable (5-17%). The average rates of generation are: 0,09kg of total waste/outpatient assistance and 0,09kg of infectious-sharps waste/outpatient procedure. The compliance with regulations, initially 26-30%, then reached 30-38% a year later. CONCLUSION: the tool showed to be easy to use, bypassing the existence of a complex range of existing regulatory requirements, allowed to identify non-conformities, pointed out corrective measures and evaluated the performance of waste management. In this sense, it contributes to decision making and management practices relating to waste, tasks usually assigned to nurses. It is recommended that the tool be applied in similar healthcare units for comparative studies, and implementation of necessary adaptations for other medical services.

Solid waste management in primary healthcare centers: application of a facilitation tool / Gerenciamento de resíduos sólidos em unidades básicas de saúde: aplicação de instrumento facilitador / Gestión de residuos sólidos en las unidades básicas de salud: aplicación de instrumento facilitador

Abstract Objectives: to propose a tool to facilitate diagnosis, formulation and evaluation of the Waste Management Plan in Primary Healthcare Centers and to present the results of the application in four selected units. Method: descriptive research, covering the stages of formulation /application of the proposed instrument and the evaluation of waste management performance at the units. Results: the tool consists in five forms; specific indicators of waste generation for outpatients healthcare units were proposed, and performance indicators that give scores for compliance with current legislation. In the studied units it is generated common waste (52-60%), infectious-sharps (31-42%) and recyclable (5-17%). The average rates of generation are: 0,09kg of total waste/outpatient assistance and 0,09kg of infectious-sharps waste/outpatient procedure. The compliance with regulations, initially 26-30%, then reached 30-38% a year later. Conclusion: the tool showed to be easy to use, bypassing the existence of a complex range of existing regulatory requirements, allowed to identify non-conformities, pointed out corrective measures and evaluated the performance of waste management. In this sense, it contributes to decision making and management practices relating to waste, tasks usually assigned to nurses. It is recommended that the tool be applied in similar healthcare units for comparative studies, and implementation of necessary adaptations for other medical services.

Resumo Objetivos: propor instrumento para facilitar diagnóstico, elaboração e avaliação de Plano de Gerenciamento de Resíduos em Unidades Básicas de Saúde e apresentar os resultados da aplicação em quatro unidades selecionadas. Método: pesquisa descritiva que contemplou as etapas de construção/aplicação do instrumento proposto e a avaliação de desempenho do gerenciamento de resíduos nas unidades estudadas. Resultados: geração de instrumento composto por cinco formulários; proposta de indicadores específicos de geração de resíduos para unidades assistenciais de saúde sem internação e indicador de desempenho que pontua o atendimento à legislação vigente. Nas unidades estudadas, são gerados resíduos comuns (52-60%), infectantes/perfurocortantes (31-42%) e recicláveis (5-17%). As taxas médias de geração são: 0,09kg de resíduos totais/atendimento e 0,09kg de resíduos infectantes-perfurocortantes/procedimento. O atendimento à normativa, inicialmente de 26-30%, atingiu 30-38% um ano depois. Conclusão: o instrumento mostrou-se de fácil aplicação, contornando a existência de complexa gama de requisitos regulatórios vigentes, possibilitou identificar não conformidades, apontar medidas corretivas e avaliar o desempenho da gestão de resíduos. Nesse sentido, contribui para tomada de decisão e práticas gerenciais referentes aos resíduos, tarefas geralmente atribuídas a enfermeiros. Recomenda-se a aplicação do instrumento em unidades de saúde similares para estudos comparativos, e as adaptações necessárias para outros serviços de saúde.

Resumen Objetivos: proponer un instrumento para facilitar el diagnóstico, elaboración y evaluación del plan de gestión de residuos en unidades básicas de salud y presentar la aplicación de los resultados en cuatro unidades seleccionadas. Método: investigación descriptiva, cubriendo las etapas de la formulación/aplicación del instrumento propuesto y la evaluación de desempeño de la gestión de residuos en las unidades estudiadas. Resultados: el instrumento está compuesto por cinco formularios; propuesta de indicadores específicos de la generación de residuos para las unidades de atención de salud sin hospitalización e indicador de desempeño que puntúa el cumplimiento de la legislación vigente. Los residuos que generan las unidades estudiadas son de tipo común (52-60%), infecciosos/punzocortantes (31-42%) y reciclables (5-17%). Las tasas promedio de generación son: total de residuos/atendimiento 0,09kg y 0,09kg de residuos infecciosos-punzocortantes/procedimiento. El cumplimiento de la normativa, inicialmente 26-30%, alcanzó 30-38% un año más tarde. Conclusión: el instrumento se mostró fácil de usar, evita pasar por una gama compleja de disposiciones normativas existentes, permitió identificar posibles casos de incumplimiento, señalar medidas correctivas puntuales y evaluar el desempeño de la gestión de residuos. En este sentido, contribuye a la toma de decisiones y a prácticas de gestión relativas a los residuos, tareas normalmente asignadas a los enfermeros. Se recomienda la aplicación del instrumento en unidades de salud similares para estudios comparativos, y las adaptaciones necesarias para otros servicios de salud.

Duas coroas suportadas por um único implante em região estética / Two prosthetic crowns supported by a single implant in the esthetic zone

O objetivo desse relato de caso clínico foi apresentar uma opção terapêutica para casos em que há ausência de elementos dentários contíguos em região estética, por meio da utilização de duas coroas suportadas por um único implante. Recursos como compensação de tecido mole e um provisório imediato que ofereça conformação à gengiva mostraram-se previsíveis na obtenção de uma harmonia estética...

The objective of this case report was to present a therapeutic option for cases with loss of neighboring teeth, carried out by means of two prosthetic crowns supported by a single implant in the anterior maxilla.Techniques such as soft tissue augmentation and immediateprovisional implant crown are required to preserve soft tissue contour and prove predictable to achieve aesthetic harmony...