Poor Sleep quality and health-related quality of life impact in adolescents with and without chronic immunosuppressive conditions during COVID-19 quarantine

OBJECTIVE: To assess the possible factors that influence sleep quality in adolescents with and without chronic immunosuppressive conditions quarantined during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This cross-sectional study included 305 adolescents with chronic immunocompromised conditions and 82 healthy adolescents. Online surveys were completed, which included questions on socio-demographic data and self-rated healthcare routine during COVID-19 quarantine and the following validated questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Pediatric Quality of Life Inventory 4.0 (PedsQL4.0), and Pediatric Outcome Data Collection Instrument (PODCI). RESULTS: The median current age [14 (10-18) vs. 15 (10-18) years, p=0.847] and frequency of female sex (62% vs. 58%, p=0.571) were similar in adolescents with chronic conditions compared with healthy adolescents. The frequency of poor sleep quality was similar in both groups (38% vs. 48%, p=0.118). Logistic regression analysis, including both healthy adolescents and adolescents with chronic conditions (n=387), demonstrated that self-reported increase in screen time (odds ratio [OR] 3.0; 95% confidence interval [CI] 1.3-6.8; p=0.008) and intrafamilial violence report (OR 2.1; 95% CI 1.2-3.5; p=0.008) were independently associated with poor sleep quality in these adolescents. However, the PODCI global function score was associated with a lower OR for poor sleep quality (OR 0.97; 95% CI 0.94-0.99; p=0.001). Further logistic regression, including only adolescents with chronic conditions (n=305), demonstrated that self-reported increase in screen time (OR 3.1; 95% CI 1.4-6.8; p=0.006) and intrafamilial violence report (OR 2.0; 95% CI 1.2-3.4; p=0.011) remained independently associated with poor quality of sleep, whereas a lower PODCI global function score was associated with a lower OR for sleep quality (OR 0.96; 95% CI 0.94-0.98; p<0.001). CONCLUSION: Self-reported increases in screen time and intrafamilial violence report impacted sleep quality in both healthy adolescents and those with chronic conditions. Decreased health-related quality of life was observed in adolescents with poor sleep quality.

Lower genital tract infections in young female juvenile idiopathic arthritis patients

Abstract Background: To evaluate human papillomavirus (HPV), Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in juvenile idiopathic arthritis (JIA) patients. Methods: After exclusion, 33 female adolescent and young JIA patients (ILAR criteria) and 28 healthy controls were selected for this study. Demographic data, gynecological, sexual function, cervical cytology and histological abnormalities were evaluated. JIA clinical/laboratorial parameters and treatment were also assessed. HPV-DNA, CT-DNA and NG-DNA testing in cervical specimens were performed by Hybrid Capture 2 assays. Results: The mean current age was similar in JIA patients and controls (23.3 ± 6.24 vs. 26.1 ± 6.03 years, p = 0.09). The frequencies of sexual intercourse (76% vs. 89%, p = 0.201) and abnormal cervical cytology (24% vs. 11%, p = 0.201) were similar in JIA compared to controls. The higher frequency of HPV infection in JIA patients than controls (30% vs. 11%, p = 0.155) did not reach statistical significance. CT (0% vs. 7%, p = 0.207) and NG infections (0% vs. 4%, p = 0.459) were also alike in both groups. Further evaluation of JIA patients with abnormal and normal cervical cytology showed that the former group had a higher frequency of HPV infection (87% vs. 12%, p = 0.0002) with a low frequency of HPV vaccination (0% vs. 8%, p = 1.0). No differences were evidenced between these two JIA groups regarding demographic data, sexual function and clinical/laboratorial parameters. The frequencies of methotrexate (p =0.206) and biological agent use (p =0.238) were similar in both JIA groups. Conclusions: To our knowledge, this was the first study to assess lower genital infections in JIA patients allowing the identification of HPV as main cause of cervical dysplasia. Methotrexate and biological agents do not seem to increase risk of lower genital tract infections in JIA patients.

Substance use and sexual function in juvenile idiopathic arthritis / Uso de substâncias e função sexual na artrite idiopática juvenil

ABSTRACT Objective: To evaluate alcohol/tobacco/illicit drug use and sexual function in adolescent juvenile idiopathic arthritis (JIA) and healthy controls. Methods: 174 adolescents with pediatric rheumatic diseases were selected. A cross-sectional study with 54 JIA patients and 35 controls included demographic/anthropometric data and puberty markers assessments, physician-conducted CRAFFT (car/relax/alone/forget/friends/trouble) screen tool for substance abuse/dependence high risk and a questionnaire that evaluated sexual function, bullying and alcohol/tobacco/illicit drug use. Clinical/laboratorial data and treatment were also assessed in JIA. Results: The median current age was similar between JIA patients and controls [15(10–19) vs. 15(12–18) years, p = 0.506]. Frequencies of alcohol/tobacco/illicit drug use were high and similar in both JIA and controls (43% vs. 46%, p = 0.829). However, age at alcohol onset was significantly higher in those with JIA [15(11–18) vs. 14(7–18) years, p = 0.032], particularly in polyarticular onset (p = 0.040). High risk for substance abuse/dependence (CRAFFT score ≥ 2) was found in both groups (13% vs. 15%, p = 1.000), likewise bullying (p = 0.088). Further analysis of JIA patients regarding alcohol/tobacco/illicit drug use showed that the median current age [17(14–19) vs. 13(10–19)years, p < 0.001] and education years [11(6–13) vs. 7(3–12)years, p < 0.001] were significant higher in those that used substances. Sexual activity was significantly higher in the former group (48% vs. 7%, p < 0.001). A positive correlation was evidenced between CRAFFT score and current age in JIA patients (p = 0.032, r = +0.296). Conclusion: A high risk for substance abuse/dependence was observed in both JIA and controls. JIA substance users were more likely to have sexual intercourse. Therefore, routine screening is suggested in all visits of JIA adolescents.

RESUMO Objetivo: Avaliar o uso de álcool/tabaco/drogas ilícitas e a função sexual em adolescentes com artrite idiopática juvenil (AIJ) e controles saudáveis. Métodos: Selecionaram-se 174 adolescentes com doenças reumatológicas pediátricas. Fez-se um estudo transversal com 54 pacientes com AIJ e 35 controles. Foram feitas avaliações de dados demográficos/antropométricos e marcadores da puberdade; a escala de triagem CRAFFT (carro/relaxar/sozinho/esquecer/amigos/problemas) foi aplicada por um médico para determinar o alto risco de uso abusivo/dependência de substâncias. Um questionário avaliou a função sexual, a ocorrência de bullying e o uso de álcool/tabaco/drogas ilícitas. Também foram avaliados dados clínicos/laboratoriais e de tratamento da AIJ. Resultados: A média da idade atual foi semelhante entre pacientes com AIJ e controles [15 (10 a 19) vs. 15 (12 a 18) anos, p = 0,506]. As frequências de uso de álcool/tabaco/drogas ilícitas foram elevadas e semelhantes entre pacientes com AIJ e controles (43% vs. 46%, p = 0,829). No entanto, a idade em que começou a usar álcool foi significantemente maior naqueles com AIJ [15 (11 a 18) vs. 14 (7 a 18 anos), p = 0,032], em particular na doença de início poliarticular (p = 0,040). Encontrou-se um alto risco de uso abusivo/dependência de substâncias (pontuação no CRAFFT ≥ 2) em ambos os grupos (13% vs. 15%, p = 1,000), do mesmo modo que o bullying (p = 0,088). Uma análise mais aprofundada dos pacientes com AIJ em relação ao uso de álcool/tabaco/drogas ilícitas mostrou que a média da idade atual [17 (14 a 19) vs. 13 (10 a 19) anos, p < 0,001] e os anos de escolaridade [11 (6 a 13) vs. 7 (3 a 12) anos, p < 0,001] foram significativamente maiores naqueles que usaram substâncias. A atividade sexual foi significantemente maior no primeiro grupo (48% vs. 7%, p < 0,001). Foi evidenciada correlação positiva entre a pontuação na escala CRAFFT e a idade atual dos pacientes com AIJ (p = 0,032, r = + 0,296). Conclusão: Observou-se um alto risco de uso abusivo/dependência de substâncias em pacientes com AIJ e controles. Os usuários de substâncias que têm AIJ são mais propensos a ter relações sexuais. Portanto, sugere-se a triagem de rotina em todas as consultas de adolescentes com AIJ.

Immunization consensus for children and adolescents with rheumatic diseases / Consenso de imunização para crianças e adolescentes com doenças reumatológicas

Crianças e adolescentes com doenças reumatológicas apresentam maior prevalência de doenças infecciosas quando comparados com a população em geral, em decorrência de atividade da doença, possível deficiência imunológica secundária à própria doença, ou uso de terapia imunossupressora. A vacinação é uma medida eficaz para a redução da morbidade e mortalidade nesses pacientes. O objetivo deste artigo foi realizar um consenso de eficácia e segurança das vacinas em crianças e adolescentes com doenças reumatológicas infantis baseadas em níveis de evidência científica. Imunização passiva para os pacientes e orientações para as pessoas que convivem com doentes imunodeprimidos também foram incluídas. Os 32 pediatras reumatologistas membros do Departamento de Reumatologia da Sociedade de Pediatria de São Paulo (SPSP) e/ou da Comissão de Reumatologia Pediátrica da Sociedade Brasileira de Reumatologia elaboraram o consenso, sendo que alguns desses profissionais estão envolvidos em pesquisas e publicações científicas nesta área. A pesquisa dos termos eficácia e/ou segurança das diferentes vacinas em crianças e adolescentes com doenças reumatológicas foi realizada nas bases de Medline e Scielo, de 1966 até março de 2009, incluindo revisões, estudos controlados e relatos de casos. O grau de recomendação e o nível científico de evidências dos estudos foram classificados em quatro níveis para cada vacina. De um modo geral, as vacinas inativadas e de componentes são seguras nos pacientes com doenças reumatológicas, mesmo em uso de terapias imunossupressoras. Entretanto, vacinas com agentes vivos atenuados são, em geral, contraindicadas para os pacientes imunossuprimidos.

Incidence of infectious diseases is higher in children and adolescents with rheumatic diseases than in the general population due to disease activity, possible immune deficiency secondary to the disease itself, or the use of immunosuppressive drugs. Vaccination is effective in reducing morbidity and mortality in those patients. The objective of this study was to establish an evidence-based consensus on the efficacy and safety of vaccination in children and adolescents with rheumatic diseases. Passive immunization of patients and guidelines for people who live with immunosuppressed patients were also included. The 32 pediatric rheumatologists of the Rheumatology Department of the Pediatrics Society of São Paulo, (SPSP, from the Portuguese), São Paulo, SP, Brazil, and/or the Commission on Pediatrics Rheumatology of the Brazilian Society of Rheumatology are responsible for this consensus; some of those professionals are involved on research and scientific publications in this field. The words efficacy and/or safety of different vaccines in children and adolescents with rheumatologic diseases were searched in Medline and Scielo data bases from 1966 to March 2009, including reviews, controlled studies, and case reports. The degree of recommendation and the scientific evidence of the studies were classified in four levels for each vaccine. As a rule, inactive and protein components vaccines are safe for patients with rheumatologic diseases, even in the presence of immunosuppressive therapy. However, live attenuated vaccines are, in general, contraindicated for immunosuppressed patients.

Hypertension in employees of a University General Hospital

OBJETIVO: Conhecer a prevalência de hipertensão arterial em funcionários de um complexo hospitalar e relacionar com variáveis sócio demográficas. MÉTODOS: Foi medida a pressão arterial com aparelho de coluna de mercúrio e manguito adequado à circunferência do braço, o peso e a altura em amostra de 864 dos 9.905 funcionários do Hospital Universitário estratificada de acordo com sexo, idade e ocupação. RESULTADOS: A prevalência de hipertensão foi de 26% (hipertensão referida = 62% ou pressão sistólica > 140 e/ou > 90 mm Hg no momento da medida = 38%). Dos que referiram 51% estavam hipertensos no momento da medida. A prevalência foi 17, 23 e 29% (p < 0,05) nos médicos, enfermagem e "outros". Análise univariada mostrou "odds ratio" significante para o sexo masculino, idade > 50 anos, unidade de trabalho para o Instituto de Radiologia e Prédio da Administração, escolaridade 10 anos e índice de massa corporal (IMC) maior ou igual a 30 kg/m2. O modelo de regressão logística com procedimento "stepwise" mostrou associação estatisticamente significante com hipertensão arterial para as variáveis: sexo, idade, cor da pele, renda familiar e IMC. CONCLUSÃO: A prevalência de hipertensão foi alta em funcionários do Complexo Hospital das Clínicas, principalmente nos de ocupação diferente de médico e enfermagem. Os grupos de maior risco (homens, cor preta, baixa renda familiar, obesos) precisam ser orientados quanto a prevenção e diagnóstico precoce da doença através de programas especiais.