Depression in hemodialysis patients: the role of dialysis shift.

OBJECTIVE: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. Evidence demonstrating the association between dialysis shift and depression is lacking; thus, obtaining such evidence was the main objective of this study. METHOD: This cross-sectional study included patients attending a hemodialysis program. Depression was diagnosed using Beck's Depression Inventory. Excessive daytime sleepiness was evaluated using the Epworth Sleepiness Scale. RESULTS: A total of 96 patients were enrolled (55 males, age 48±14 years). Depression and excessive daytime sleepiness were observed in 42.7% and 49% of the patients, respectively. When comparing variables among the three dialysis shifts, there were no differences in age, dialysis vintage, employment status, excessive daytime sleepiness, hemoglobin, phosphorus levels, or albumin levels. Patients in the morning shift were more likely to live in rural areas (p<0.0001), although patients in rural areas did not have a higher prevalence of depression (p = 0.30). Patients with depression were more likely to be dialyzed during the morning shift (p = 0.008). Independent risk factors for depression were age (p<0.03), lower levels of hemoglobin (p<0.01) and phosphorus (p<0.01), and dialysis during the morning shift (p = 0.0009). The hospitalization risk of depressive patients was 4.5 times higher than that of nondepressive patients (p<0.008). CONCLUSION: These data suggest that depression is associated with dialysis shift, higher levels of phosphorus, and lower levels of hemoglobin. The results highlight the need for randomized trials to determine whether this association occurs by chance or whether circadian rhythm disorders may play a role.

Depression in hemodialysis patients: the role of dialysis shift

OBJECTIVE: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. Evidence demonstrating the association between dialysis shift and depression is lacking; thus, obtaining such evidence was the main objective of this study. METHOD: This cross-sectional study included patients attending a hemodialysis program. Depression was diagnosed using Beck's Depression Inventory. Excessive daytime sleepiness was evaluated using the Epworth Sleepiness Scale. RESULTS: A total of 96 patients were enrolled (55 males, age 48±14 years). Depression and excessive daytime sleepiness were observed in 42.7% and 49% of the patients, respectively. When comparing variables among the three dialysis shifts, there were no differences in age, dialysis vintage, employment status, excessive daytime sleepiness, hemoglobin, phosphorus levels, or albumin levels. Patients in the morning shift were more likely to live in rural areas (p<0.0001), although patients in rural areas did not have a higher prevalence of depression (p = 0.30). Patients with depression were more likely to be dialyzed during the morning shift (p = 0.008). Independent risk factors for depression were age (p<0.03), lower levels of hemoglobin (p<0.01) and phosphorus (p<0.01), and dialysis during the morning shift (p = 0.0009). The hospitalization risk of depressive patients was 4.5 times higher than that of nondepressive patients (p<0.008). CONCLUSION: These data suggest that depression is associated with dialysis shift, higher levels of phosphorus, and lower levels of hemoglobin. The results highlight the need for randomized trials to determine whether this association occurs by chance or whether circadian rhythm disorders may play a role. .

Fatores psicossociais associados à saúde mental de crianças no início da escolarização: um estudo sobre escolares de famílias

O Brasil possue altas taxas de repetência escolar e muitos estudantes são encaminhados pelas escolas para atendimento em saúde mental, por apresentarem dificuldades escolares. Existe uma escassez de trabalhos sobre epidemiologia psiquiátrica infantil no país. O conhecimento acerca da saúde mental de crianças ao ingressarem no sistema educacional pode orientar o planejamento de trabalhos preventivos e de atendimento à saúde mental do estudante, além de subsidiar estudos, sobre a influência da escola na saúde mental dos estudantes...Brazil has high rates of school failure and many students are referred by schools to mental health care, because they have learning difficulties. There is a lack of studies on child psychiatric epidemiology in the country. The knowledge about the health of children menatl to join the educational sitema can guide the planning of preventive work and mental health care of the student, in addition to supporting studies on the influence of the mental health of school students ...

[Life-long domestic violence against women: prevalence and immediate impact on health, work, and family]. / Violência conjugal física contra a mulher na vida: prevalência e impacto imediato na saúde, trabalho e família.

OBJECTIVES: To estimate the lifetime prevalence of domestic violence against women (DVAW) in a low-income urban community and evaluate the immediate impact of DVAW on health, work, and family life. METHODS: The present cross-sectional study was carried out in the city of Embu (state of São Paulo, Brazil) as part of an international multicenter project (World Studies of Abuse in the Family Environment, WorldSAFE). A probabilistic sample of census sector-based clusters including all eligible households identified was used. A total of 784 women (age 16-49 years) with at least one child younger than 18 years and a lifetime resident husband/partner were included. We evaluated the occurrence of any kind of DVAW (slapping, kicking, hitting, beating, threatening to use or using a weapon, other aggressions mentioned spontaneously), of severe DVAW (same items, except slapping and other aggressions informed spontaneously), and of immediate impacts on the health, work, and family of the victims. RESULTS: The prevalence of DVAW was 26.0% for any kind of violence and 18.5% for severe DVAW. Among the victims of any kind of DVAW, 38.7% judged that they needed medical care, 4.4% were hospitalized, 18.1% were incapacitated for work (paid work or household chores), 51.5% left their partner due to the aggression and 66.7% had children who witnessed the violence. For severe violence, these rates were 51.0, 5.5, 23.4, 59.3 and 75.9%, respectively. Shame and fear of retaliation obstructed access to medical care. CONCLUSIONS: The frequency of DVAW is high in the studied community and produces immediate impacts on the victim's health, work, and family life. These impacts decrease the victim's ability to look for help and hinder the breaking of the cycle of violence.

Violência conjugal física contra a mulher na vida: prevalência e impacto imediato na saúde, trabalho e família / Life-long domestic violence against women: prevalence and immediate impact on health, work, and family

Objetivos: Estimar a prevalência de violência conjugal física contra a mulher ao longo da vida (VCFM) em uma comunidade urbana de baixa renda e avaliar o seu impacto imediato na saúde, trabalho e vida familiar. Métodos: O presente estudo de corte transversal foi realizado em Embu, Estado de São Paulo, como componente do projeto multicêntrico internacional World Studies of Abuse in the Family Environment (WorldSAFE). Foi utilizada uma amostra probabilística de conglomerados derivados de setores censitários, incluindo todos os domicílios elegíveis identificados em cada um deles. Participaram 784 mulheres (16 a 49 anos) com pelo menos um filho menor de 18 anos e marido/companheiro residente (ao longo da vida). Foi avaliada a ocorrência de algum tipo de VCFM (tapa, chute, soco, espancamento, uso/ameaça de uso de arma, outras agressões físicas espontaneamente referidas), de VCFM grave (mesmos itens, exceto tapa e outras agressões referidas) e de impactos imediatos na saúde, trabalho e vida familiar das vítimas. Resultados: A prevalência de VCFM foi de 26,0 por cento para algum tipo de violência e de 18,5 por cento para violência grave. Entre as vítimas de algum tipo de VFCM, 38,7 por cento julgaram necessitar cuidados médicos, 4,4 por cento foram hospitalizadas, 18,1 por cento ficaram incapacitadas para o trabalho (remunerado ou doméstico), 51,5 por cento separaram-se devido às agressões e 66,7 por cento tiveram filhos testemunhando a violência. Para a violência grave, essas taxas foram de 51,0, 5,5, 23,4, 59,3 e 75,9 por cento, respectivamente. A vergonha e o medo de represália por parte do companheiro dificultaram o acesso à assistência médica. Conclusões: A VCFM é frequente na comunidade estudada e produz impactos imediatos na saúde, trabalho e vida familiar das vítimas. Esses impactos diminuem a capacidade da vítima de buscar socorro e dificultam a interrupção do ciclo da violência.

Objectives: To estimate the lifetime prevalence of domestic violence against women (DVAW) in a low-income urban community and evaluate the immediate impact of DVAW on health, work, and family life. Methods: The present cross-sectional study was carried out in the city of Embu (state of São Paulo, Brazil) as part of an international multicenter project (World Studies of Abuse in the Family Environment, WorldSAFE). A probabilistic sample of census sector-based clusters including all eligible households identified was used. A total of 784 women (age 16-49 years) with at least one child younger than 18 years and a lifetime resident husband/partner were included. We evaluated the occurrence of any kind of DVAW (slapping, kicking, hitting, beating, threatening to use or using a weapon, other aggressions mentioned spontaneously), of severe DVAW (same items, except slapping and other aggressions informed spontaneously), and of immediate impacts on the health, work, and family of the victims. Results: The prevalence of DVAW was 26.0 percent for any kind of violence and 18.5 percent for severe DVAW. Among the victims of any kind of DVAW, 38.7 percent judged that they needed medical care, 4.4 percent were hospitalized, 18.1 percent were incapacitated for work (paid work or household chores), 51.5 percent left their partner due to the aggression and 66.7 percent had children who witnessed the violence. For severe violence, these rates were 51.0, 5.5, 23.4, 59.3 and 75.9 percent, respectively. Shame and fear of retaliation obstructed access to medical care. Conclusions: The frequency of DVAW is high in the studied community and produces immediate impacts on the victim's health, work, and family life. These impacts decrease the victim's ability to look for help and hinder the breaking of the cycle of violence.