Differential diagnosis of bone marrow failure syndromes guided by machine learning.

The choice to postpone treatment while awaiting genetic testing can result in significant delay in definitive therapies in patients with severe pancytopenia. Conversely, the misdiagnosis of inherited bone marrow failure (BMF) can expose patients to ineffectual and expensive therapies, toxic transplant conditioning regimens, and inappropriate use of an affected family member as a stem cell donor. To predict the likelihood of patients having acquired or inherited BMF, we developed a 2-step data-driven machine-learning model using 25 clinical and laboratory variables typically recorded at the initial clinical encounter. For model development, patients were labeled as having acquired or inherited BMF depending on their genomic data. Data sets were unbiasedly clustered, and an ensemble model was trained with cases from the largest cluster of a training cohort (n = 359) and validated with an independent cohort (n = 127). Cluster A, the largest group, was mostly immune or inherited aplastic anemia, whereas cluster B comprised underrepresented BMF phenotypes and was not included in the next step of data modeling because of a small sample size. The ensemble cluster A-specific model was accurate (89%) to predict BMF etiology, correctly predicting inherited and likely immune BMF in 79% and 92% of cases, respectively. Our model represents a practical guide for BMF diagnosis and highlights the importance of clinical and laboratory variables in the initial evaluation, particularly telomere length. Our tool can be potentially used by general hematologists and health care providers not specialized in BMF, and in under-resourced centers, to prioritize patients for genetic testing or for expeditious treatment.

A guide to prepare patients with inflammatory bowel diseases for anti-TNF-α therapy.

Current therapy of moderate-to-severe inflammatory bowel disease (IBD) often involves the use of anti-tumor necrosis factor alpha (TNF-α) agents. Although very effective, theses biologics place the patient at increased risk for developing infections and lymphomas, the latter especially when in combination with thiopurines. Appropriate patient selection, counseling, and education are all important features for the successful use of anti-TNF-α therapy. A thorough history to rule-out contraindications of this therapy and emphasis on monitoring guidelines are important steps preceding administration of anti-TNF-α agents. This therapy should only be considered if a recent evaluation has established that the patient has active IBD. In addition, it is important to exclude disease mimickers. Anti-TNF-α agents have been considered to present a globally favorable benefit/risk ratio. However, it is important that in routine practice, initiation of anti-TNF-α therapy be carefully discussed with the patient, extensively explaining the potential benefits and risks of such treatment. Prior to starting anti-TNF-α therapy, the patients need to be screened for latent tuberculosis, hepatitis B virus infection, and (usually) hepatitis C virus and HIV infection. Vaccination schedules of IBD patients should be evaluated and updated prior to the commencement of anti-TNF-α therapy. Ordinarily, immunization in adult patients with IBD should not deviate from recommended guidelines for the general population. With the exception of live vaccines, immunizations can be safely administered in patients with IBD, even those on immunosuppressants or biologics. The purpose of this review is providing an overview of appropriate steps to prepare patients with IBD for anti-TNF-α therapy.

Longitudinal profile of post-traumatic symptoms in HealthCare Workers during COVID-19 pandemic: A latent transition model.

INTRODUCTION: Pandemics have the potential to be considered traumatic event, increasing the risk of developing post-traumatic stress symptoms (PTSS) in HealthCare Workers (HCW). However, few longitudinal studies have evaluated the impact of prolonged exposure to the risk imposed by COVID-19. Our aim was to identify subgroups of HCW with profiles of PTSS, how this profile changed during the pandemic and which variables were related to these changes. METHODS: We evaluated the levels of PTSS and psychological distress in a Brazilian HealthCare Workers' sample (n = 1398) in three waves of assessment: from May to June 2020 (Wave 1), December 2020 to February 2021 (Wave 2) and May to August 2021 (Wave 3), using Latent Profile Analysis (LPA) to identify subgroups with different profiles of symptms, and then, Latent Transition Analysis (LTA) was applied to examine changes in symptom profiles over time, including gender, psychiatric diagnosis history, and pandemic-related fears as covariates. RESULTS: two profiles were identified: high-PTSS profile (Wave 1-23%; Wave 2-64% and Wave 3-73%) and a low-PTSS (Wave 1-77%; Wave 2-36% and Wave 3-27%). Being female, fear of contamination, and fearing financial problems were strong predictors of changes in the profile. In addition, the participants had a high probability of being in the high-PTSS in the long run. CONCLUSION: These results suggests that targeted interventions can mitigate the impact of pandemic. Providing financial support, and psychological support can be beneficial for those with psychiatric diagnoses and experiencing bereavement.

Decision-making styles during stressful scenarios: The role of anxiety in COVID-19 pandemic.

Introduction: Decision-making is not purely rational but highlighted by the influence of intuitive and emotional processes. Recently, researchers have focused more attention on understanding which environmental and personal features influence decision-making processes, and how. Objective and methods: On this study, we investigate whether Trait Anxiety moderates the impact of Post-Traumatic Stress (PTS) symptoms reported during COVID-19 pandemic on decision-making styles. Results: The study included 1,358 Brazilian participants (80% women) aged between 20 and 74 (M = 41.11; SD = 11.23) who responded to an online survey between May and August of the year 2021 of COVID-19 pandemic to The State-Trait Anxiety Inventory, The Decisions Styles Scale, The Impact of Event Scale - Revised and questions related to COVID-19. Through moderation analysis, we observed that experiencing PTS is associated with a higher tendency to biased/heuristic decision-making processes. Discussion: Trait Anxiety seems to influence how people respond to PTS symptoms on decision-making related processes. Subjects with higher Trait Anxiety reported lower tendency to appeal to rationality, especially under higher reported levels of PTS. Meanwhile, lower Trait Anxiety subjects exhibited more reason-based decision-making under higher rates of PTS. This work contributes to a deeper understanding of the interplay among environmental and individual differences on decision-making styles and helps to identify factors of vulnerability for poorer cognitive functioning on stressful scenarios.

Impact of Plasmodium vivax malaria on executive and cognitive functions in elderlies in the Brazilian Amazon.

The exact path leading to cognitive impairment that goes beyond malaria is unclear, but it appears to be the result of interactive factors. Time of exposure to disease and recurrences are potentially major determinant variables. Cognitive impairment is described mainly in children, rarely in adults. The disease in high endemic areas usually does not affect elderlies, because of acquired immunity over time. However, this population is relatively more frequently sick in lower endemic areas, such as in the Amazon. This study assessed the effect of Plasmodium vivax malaria on the executive and cognitive functions of elderlies, in the Brazilian Amazon. A cohort study was conducted to evaluate executive and cognitive functions one week (T0), two months (T2) and eight months (T8) after the malaria episode. Mini-Mental State Examination (MMSE), Beck Depression Inventory II (BDI-II), Clock Drawing Test (CDT), Wechsler adult intelligence scale (WAIS-III), and Wisconsin Card Sorting Test (WCST) were used to assess executive and cognitive functions. One hundred-forty elderlies were enrolled (70 with P. vivax malaria and 70 without malaria). P. vivax malaria was associated with impairment of the executive and cognitive functions in elderlies for up to 8 months after acute P. vivax malaria. Prior history of malaria, recurrences and higher parasitemia were independently associated with various surrogates of executive and cognitive impairment. With the increase in life expectancy, elderlies living in malaria endemic areas will deserve more attention from health authorities, to guarantee improvement of their quality of life in the tropics.

The mental health of Brazilian healthcare professionals during the COVID-19 pandemic: a longitudinal study.

OBJECTIVE: To compare the distress level among Brazilian healthcare professionals during the coronavirus disease 2019 (COVID-19) pandemic and estimate risks by sex, age, and occupation. METHODS: In a longitudinal cohort design, a nationally distributed online survey was used to collect data from 10,490 active healthcare professionals who worked during the pandemic. Participants were mostly female, aged 18 to 82 years; 13 different health professions and all states of Brazil were represented. RESULTS: The most frequent professions were psychology, dentistry, and nursing. The Brief Symptom Inventory (BSI) score suggested an increased distress perception among health professionals. Females showed poorer mental health than males, but the absolute rise in Global Severity Index (GSI) score was larger in males than in females. Younger adults reported more symptoms of psychological distress than older adults. The most impacted age group was between 30-39 years. Nurse technicians presented the highest risk of distress. CONCLUSION: Health professionals are essential to overcoming the pandemic; thus, their mental health status should be monitored, and features associated with increased distress should be identified. Our findings suggest distress risk should be stratified by occupation, age, and sex. Health professionals showed an increased distress perception. Women, individuals between the ages of 30 and 39, nursing personnel, and physicians were more likely to report distress compared with other health professionals.

Longitudinal invariance and validity of the Impact of Event Scale-Revised under COVID-19 pandemic in a Brazilian sample.

Although the Impact Event Scale-Revised is widely used, its factor structure is still controversial. In addition, its longitudinal measurement invariance (LMI) remains uninvestigated. In this sense, we carried out three studies to investigate its psychometric properties. In Study 1, we evaluated the factorial structure of the scale comparing the different models existing in the literature in Brazilian samples who responded to the instrument during the COVID-19 pandemic. In Study 2, we provide support for a five-factor model throughout convergent validity with psychological distress and sleep problems, and criterion validity between people with diagnostic of mental disorders. Finally, we evaluated the LMI over a 6-month interval. The results indicated that the five-factor model has excellent goodness of fit and holds strict longitudinal invariance. Additionally, internal consistency and stability coefficients indicate that the scale is appropriate to measure posttraumatic stress symptomatology) in nonclinical samples across multiple assessments. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Gender invariance and psychometric properties of a Brazilian version of the Emotion Regulation Questionnaire (ERQ).

INTRODUCTION: Emotion regulation refers to use of strategies to change or suppress a response to an affective experience and is an important component of an individual's subjective wellbeing. Difficulties properly regulating emotions are related to psychopathological processes. OBJECTIVE: This study assessed the factor structure of the Brazilian version of the Emotion Regulation Questionnaire (ERQ); the invariance of its psychometric parameters as a function of gender; and its convergent validity with other scales measuring affective processes. METHOD: A total of 813 adults (73.7% women), aged between 18 and 64 years and with a high educational level used an electronic platform to complete the ERQ, the Positive and Negative Affect Schedule (PANAS), the Affect Scale (AS), and the Difficulties in Emotion Regulation Scale (DERS). Factor structure, reliability, and validity of the adapted version of the ERQ were investigated. RESULTS: Multi-group confirmatory factor analysis (MGCFA) revealed adequate goodness of fit for the ERQ's two-factor model (cognitive reappraisal and emotional suppression), providing evidence of invariance of its psychometric parameters as a function of gender. Correlations between the ERQ's factors and measures of affect and emotional dysregulation presented positive indicators, with significant associations between emotion regulation and affective experiences depending on gender. CONCLUSION: The ERQ presents good psychometric indicators for use with the Brazilian population.

Increased risk of health professionals to feel traumatized during the COVID-19 pandemic.

Health professionals may be a vulnerable group to posttraumatic stress symptoms (PTSS) during the Coronavirus disease 2019 (COVID-19) pandemic. To investigate how health professionals who experienced a traumatic event are expressing PTSS and factors related to risk for higher PTSS symptomatology can inform how health professionals are facing their role in this crisis. This was an Internet cross-sectional survey. Participants were 49,767 Brazilian health professionals who have ever faced a traumatic event, which was about 25.9% of an initial sample of health professionals. PTSS symptoms were assessed using the Impact of Event Scale-Revised (IES-R) and latent profile analysis (LPA) explored subpopulations within participants based on their scores. Distinct profiles were compared for psychological distress (e.g., depression and anxiety) and quality of life. Multinomial logistic regression analysis was conducted to investigate the relationship between IES-R profiles and COVID-19 related experiences, thoughts, and perceptions. A two-profile model was the most appropriate for the IES-R data pointing out a group with a high level of PTSS (named high-PTSS; n = 10,401, 20.9%) and another expressing a low level of symptoms (named low-PTSS; n = 39,366, 79.1%). The high-PTSS profile demonstrated worse psychological scores (global psychological distress, somatization, depression, and anxiety) and worse quality of life (physical, psychological, social, and environmental) with moderate magnitudes. Small but significant predictors of the high-PTSS profile included sociodemographic characteristics and COVID-19 related experiences, thoughts, and perceptions. Most individuals who experienced a traumatic event were not in the high-PTSS profile. For those who were, however, psychological and quality of life measures were much worse. During the initial phase of the COVID-19 pandemic, several characteristics emerged as risks to report trauma.

Validity and precision of the International Physical Activity Questionnaire for climacteric women using computational intelligence techniques.

This study aimed to evaluate the validity and precision of the International Physical Activity Questionnaire (IPAQ) for climacteric women using computational intelligence techniques. The instrument was applied to 873 women aged between 40 and 65 years. Considering the proposal to regroup the set of data related to the level of physical activity of climacteric women using the IPAQ, we used 2 algorithms: Kohonen and k-means, and, to evaluate the validity of these clusters, 3 indexes were used: Silhouette, PBM and Dunn. The questionnaire was tested for validity (factor analysis) and precision (Cronbach's alpha). The Random Forests technique was used to assess the importance of the variables that make up the IPAQ. To classify these variables, we used 3 algorithms: Suport Vector Machine, Artificial Neural Network and Decision Tree. The results of the tests to evaluate the clusters suggested that what is recommended for IPAQ, when applied to climacteric women, is to categorize the results into two groups. The factor analysis resulted in three factors, with factor 1 being composed of variables 3 to 6; factor 2 for variables 7 and 8; and factor 3 for variables 1 and 2. Regarding the reliability estimate, the results of the standardized Cronbach's alpha test showed values between 0.63 to 0.85, being considered acceptable for the construction of the construct. In the test of importance of the variables that make up the instrument, the results showed that variables 1 and 8 presented a lesser degree of importance and by the analysis of Accuracy, Recall, Precision and area under the ROC curve, there was no variation when the results were analyzed with all IPAQ variables but variables 1 and 8. Through this analysis, we concluded that the IPAQ, short version, has adequate measurement properties for the investigated population.

Psychological distress in Brazilian Crohn's disease patients: screening, prevalence, and risk factors.

BACKGROUND: Psychological disturbances are frequent in Crohn's disease (CD) patients. However, epidemiological studies of non-western CD populations are limited and may be confounded by genetic and disease-related influences. The aim of this study was to assess the prevalence and risk factors for depression and symptoms of anxiety in Brazilian patients with CD. MATERIAL/METHODS: In this cross-sectional study, 110 CD patients and 110 control subjects with erosive esophagitis were assessed for depression and anxiety symptoms using the Beck Depression Inventory and the Hospital Anxiety and Depression Scale. RESULTS: The Crohn's and control groups were similar with regard to socio-demographic data. Compared with the controls, the CD patients had a significantly higher prevalence of depressed mood (25.4% vs. 8.2%, P=0.003). There was no significant difference in the prevalence of anxiety between CD subjects (33.6%) and controls (22.7%). Depressed mood rates were higher among those who had active disease and greater CDAI scores (OR: 3.4, 95%CI 1.1-10.8). Family history of depression (OR: 5.3, 95%CI: 2.7-15.1) was related to the co-occurrence of anxiety symptoms. CONCLUSIONS: In CD patients, depression and anxiety are highly concurrent conditions. Disease activity was strongly associated with depressed mood, while a family history of depression was related to anxiety. Screening for depression and anxiety should be carried out routinely as part of quality of care improvement in CD individuals.

Azathioprine therapy in steroid-dependent patients with Crohn disease: results of a 10-year longitudinal follow-up study.

BACKGROUND: Studies assessing the efficacy of azathioprine in steroid-dependent patients with Crohn's disease are scarce. The aim of this study was to assess the long-term efficacy and safety of azathioprine, and factors associated with sustained response, in steroid-dependent patients with Crohn's disease. MATERIAL/METHODS: In this prospective, observational study, adult steroid-dependent subjects with Crohn's disease receiving azathioprine therapy were assessed over a 10-year period. Azathioprine dosage was adjusted according to clinical response and occurrence of adverse events. Median treatment duration was 83 months. Steroid therapy was tapered according to protocol. RESULTS: A total of 106 subjects were included. The proportion of subjects remaining in sustained steroid-free remission at 12, 24, 36, 48, and 60 months was 0.61, 0.73, 0.72, 0.70, and 0.70, respectively. Thereafter, the rate of weaning from steroids decreased gradually, reaching a nadir of 0.41 at 108 months. Median time to complete steroid withdrawal was 6 months. Demographic, azathioprine dose, and disease-related data did not correlate with remission. By multivariate analysis, only decreased mean leukocyte count during follow-up was independently associated with steroid-free remission (P=.001). Subjects who achieved an annual mean leukocyte count <6,000/mm(3) were more likely to sustain steroid-free remission (P=.01). Serious adverse events in response to azathioprine were uncommon. CONCLUSIONS: Azathioprine therapy offers a meaningful option in the management of steroid-dependent Crohn's disease for up to 10 years. A persistent decrease in leukocyte count may provide a surrogate marker of sustained steroid-free response.

O efeito moderador do sexo na correlação entre acurácia de percepção de emoções e sintomas depressivos / The moderate role of sex in the relationship between accuracy of perception of emotions and depressive symptoms

O interesse científico pelo processamento de informações emocionais cresceu nos últimos anos, indicando uma relação importante entre percepção de emoções e diversos transtornos mentais, dentre eles a depressão, além de estar relacionado a diferenças individuais em função do sexo. Dessa forma, o presente estudo teve por objetivo avaliar o papel moderador do sexo na relação entre sintomas depressivos e déficits na percepção de emoções de jovens adultos. Para tanto, participaram deste estudo 217 universitários, com idades entre 18 e 43 anos (M = 20,8; DP = 5,6), sendo 61,3% do sexo feminino. Foram aplicados um questionário sociodemográfico, Inventários de Depressão de Beck (BDI) e imagens do Picture of Facial Affects (PoFA). Os resultados indicaram correlações negativas fracas entre sintomas depressivos e déficits na acurácia de percepção de alegria, raiva, surpresa, expressões neutras e na acurácia total, com o sexo exercendo efeito moderador nas relações observadas. O conjunto dos resultados corroboram com achados da literatura internacional indicando a necessidade de se levar em consideração o sexo como importante variável durante a avaliação de déficits na percepção de emoções associados a sintomas depressivos.

Scientific interest in the processing of emotional information has grown in recent years, indicating an important relationship between the perception of emotions and various mental disorders, including depression, associated with being related to individual differences due to sex. In this way, the present study aimed to assess the moderating role of sex in the relationship between depressive symptoms and deficits in the perception of emotions in young adults. To this end, 217 university students, aged between 18 and 43 years (M = 20.8; SD = 5 A sociodemographic questionnaire, Beck Depression Inventories (BDI), and images from the Picture of Facial Affects (PoFA) were applied. The results indicated weak negative correlations between depressive symptoms and deficits in the accuracy of perception of joy, anger, surprise, neutral expressions, and in total accuracy, with sex having a moderating effect on the observed relationships. The set of results corroborates findings from the international literature indicating the need to take gender into account as a significant variable when assessing deficits in the perception of emotions are associated with depressive symptoms.

The mental health of Brazilian healthcare professionals during the COVID-19 pandemic: a longitudinal study

Objective: To compare the distress level among Brazilian healthcare professionals during the coronavirus disease 2019 (COVID-19) pandemic and estimate risks by sex, age, and occupation. Methods: In a longitudinal cohort design, a nationally distributed online survey was used to collect data from 10,490 active healthcare professionals who worked during the pandemic. Participants were mostly female, aged 18 to 82 years; 13 different health professions and all states of Brazil were represented. Results: The most frequent professions were psychology, dentistry, and nursing. The Brief Symptom Inventory (BSI) score suggested an increased distress perception among health professionals. Females showed poorer mental health than males, but the absolute rise in Global Severity Index (GSI) score was larger in males than in females. Younger adults reported more symptoms of psychological distress than older adults. The most impacted age group was between 30-39 years. Nurse technicians presented the highest risk of distress. Conclusion: Health professionals are essential to overcoming the pandemic; thus, their mental health status should be monitored, and features associated with increased distress should be identified. Our findings suggest distress risk should be stratified by occupation, age, and sex. Health professionals showed an increased distress perception. Women, individuals between the ages of 30 and 39, nursing personnel, and physicians were more likely to report distress compared with other health professionals.

Transcultural adaptation of the Following Affective States Test (FAST) for the brazilian context / Adaptação transcultural da Following Affective States Test (FAST) para contexto do Brasil / Adaptación transcultural del Following Affective States Test (FAST) para el contexto brasileño

Individuals differ in their tendency to follow or ignore feelings as a source of information to guide behavior, and it is relevant to examine these particularities. This study presents an assessment of the psychometric properties of the transcultural adaptation of the Following Affective States Test (FAST) for the Brazilian context. After translation and back translation, the adapted version was applied among adult volunteers (n=302), both sexes (208 women, 68.9%), aged between 18 and 61 years old (M=28.6; SD=9.4) along with the Positive and Negative Affect Scale (PANAS) and the Emotion Regulation Questionnaire (ERQ). The confirmatory factor analysis (CFA) of the Brazilian version presented appropriate goodness of fit for the four-factor model (GFI=0.92; CFI=0.83; RMSEA=0.07) with appropriate internal consistency (Cronbach's alpha=0.60-0.72). Statistically significant positive correlations were found between the FAST and positive/negative affects (PANAS) and emotion regulation strategies (ERQ). The adapted version of the FAST presented promising indicators concerning validity and reliability evidence for the Brazilian context. (AU)

Indivíduos diferem em sua propensão para seguir ou ignorar suas emoções como fonte de informação para guiar seus comportamentos, sendo relevante examinar suas particularidades. Nesse campo, este estudo avaliou qualidades psicométricas da adaptação transcultural do instrumento Following Affective States Test (FAST) para o Brasil. Após tradução e retrotradução, a FAST foi aplicada em voluntários adultos (n = 302 sujeitos), de ambos os sexos (208 mulheres, 68,9%), com idade entre 18-61 anos (M = 28,6; DP = 9,4), juntamente com a Escala de Afetos Positivos e Negativos (PANAS) e o Questionário de Regulação Emocional (ERQ). A análise fatorial confirmatória (CFA) da FAST apresentou bons índices de ajuste para o modelo de quatro fatores (GFI = 0,92; CFI = 0,83; RMSEA = 0.07), com adequada consistência interna (alfa de Cronbach = 0,60-0,72). Existiram correlações estatisticamente significativas e positivas entre FAST e afetos positivos/negativos (PANAS) e com estratégias de regulação emocional (ERQ). Conclui-se que FAST apresentou indicadores promissores relativos a evidências de validade e precisão para o contexto brasileiro. (AU)

Los individuos difieren en su propensión a seguir o ignorar sus sentimientos como fuente de información para guiar su conducta, y es relevante examinar sus particularidades. En este campo, este estudio evaluó las propiedades psicométricas de la adaptación transcultural de la prueba Following Affective States Test (FAST) para el contexto brasileño. Después de la traducción y retrotraducción, FAST se aplicó a voluntarios adultos (N = 302), de ambos sexos (208 mujeres, 68.9%), con edades comprendidas entre 18 a 61 años (M = 28.6; DS = 9.4), junto con Escala de Afecto Positivo y Negativo (PANAS) y el Cuestionario de Regulación Emocional (ERQ). El análisis factorial confirmatorio (CFA) de FAST presentó buenos índices de ajuste para el modelo de cuatro factores (GFI = 0.92; CFI = 0.83; RMSEA = 0.07), con una consistencia interna adecuada (alfa de Cronbach = 0.60-0.72). Se encontraron correlaciones estadísticamente significativas y positivas entre FAST y los efectos positivos y negativos (PANAS) con las estrategias de regulación emocional (ERQ). Se concluye que FAST presentó indicadores prometedores relacionados con la evidencia de validez y la confiabilidad para el contexto brasileño. (AU)

Changes in Work and Occupational Behavior in a Brazilian Sample During the COVID-19 Pandemic: A Longitudinal Study

The COVID-19 pandemic led to changes in occupational behaviors, affecting millions of workers. This study aimed to assess changes in various perceptions about work at the beginning of the pandemic in Brazil, and six months later. 702 individuals of both sexes (566 females, 80.62%), aged between 16 and 75 years (M=41.8; SD=13.5), residents in 24 different states of Brazil (most from the Southeast region, 59.26%) participated in this research and answered an online survey about their work experience during the pandemic at two different timepoints. The questionnaire included questions about increased/decreased productivity, fear of contamination by COVID-19 at work, need for going out to work, performing voluntary work, waiting for the return of their work/study activities, previous/current experience working-from-home, use of video conference programs, performing voluntary work to fight COVID-19, job loss and incidence of health problems that prevented the participant from carrying out daily/work/study activities. The results indicated that workers experienced new ways of performing their activities, changed their perceptions about their productivity, how/where they worked, and how they felt about their routine, although the majority of variables remained stable between timepoints.(AU)

A pandemia da COVID-19 resultou em mudanças nos comportamentos ocupacionais, afetando milhões de trabalhadores. Este estudo teve como objetivo avaliar as mudanças em diferentes percepções sobre o trabalho no início da pandemia no Brasil e seis meses depois. 702 indivíduos de ambos os sexos (566 sexo feminino, 80,62%), com idade entre 16 e 75 anos (M = 41,8; DP = 13,5), residentes em 24 diferentes estados do Brasil (maioria da região Sudeste, 59,26%) participaram e responderam a uma pesquisa online sobre sua experiência de trabalho durante a pandemia em dois momentos diferentes. O questionário incluía questões sobre aumento/diminuição da produtividade, medo de contaminação pelo COVID-19 no trabalho, necessidade de sair para trabalhar, realização de trabalho voluntário, espera pelo retorno de suas atividades de trabalho/estudo, experiência anterior/atual de trabalho remoto, utilização de programas de videoconferência, realização de trabalho voluntário de combate ao COVID-19, perda de emprego e incidência de problemas de saúde que o impediram de realizar atividades cotidianas/laborais/de estudo. Os resultados indicaram que os trabalhadores vivenciaram novas formas de realizar suas atividades, mudaram suas percepções sobre sua produtividade, como/onde trabalhavam e como se sentiam em relação ao seu cotidiano, apesar da maioria das variáveis se manterem estáveis entre os dois momentos.(AU)

La pandemia del COVID-19 resultó en cambios en los comportamientos ocupacionales, afectando millones de trabajadores. Este estudio tiene como objetivo evaluar los cambios en diferentes percepciones sobre el trabajo en el inicio de la pandemia en Brasil e seis meses después. 702 individuos de ambos sexos (566 mujeres, 80,62%), con edades entre los 16 y 75 años (M=41,8; DP=13,5) 702 individuos de ambos sexos (566 mujeres, 80,62%), con edades entre 16 y 75 años (M = 41,8; DT = 13,5), residentes en 24 estados diferentes de Brasil (la mayoría de la región Sudeste, 59,26%) participaron en esta investigación y respondieron a cuestiones sobre su experiencia de trabajo durante la pandemia en dos momentos distintos. El cuestionario on-line incluía preguntas sobre aumento/disminución de la productividad, miedo a la contaminación por COVID-19 en el trabajo, necesidad de salir a trabajar, realizar trabajo voluntario, esperar el regreso de sus actividades laborales/de estudio, experiencia previa/actual trabajando home office, uso de programas de videoconferencia, realización de trabajo voluntario para combatir COVID-19, pérdida de empleo e incidencia de problemas de salud que impedían al participante realizar actividades diarias/laborales/de estudio. Los resultados indicaron que los trabajadores vivenciaron nuevas formas de realizar sus actividades, cambiaron sus percepciones sobre su productividad, como/donde trabajaban y como se sentían en relación a su cotidiano, aunque la mayoría de las variables se mantuvieron estables entre los dos momentos.(AU)

Preditores de sofrimento psicológico e prevalência de transtornos mentais autodeclarados em profissionais de saúde e na população em geral durante a pandemia de Covid-19 no Brasil / Predictors of psychological distress and prevalence of self-reported mental disorders in health care professionals and in the general population during the Covid-19 pandemic in Brazil

O fardo dos transtornos mentais pode aumentar durante a pandemia de Covid-19. Por isso, é estratégico caracterizar a saúde mental da população. Analisamos dados coletados pela Internet de 164.881 profissionais de saúde e 5.635 participantes da população geral. O Índice de Gravidade Global (GSI) do Inventário Breve de Sintomas, diagnóstico autodeclarado de transtornos mentais, características sociodemográficas, estado de saúde física, história de contato com a Covid-19, percepções e preocupações e medidas preventivas adotadas foram comparados entre as amostras. Análises de regressão múltipla foram usadas para investigação de fatores associados ao GSI. O distresse psicológico foi classificado como alto ou muito alto em 13,4% dos profissionais de saúde e em 31,4% dos participantes da população geral. A prevalência de transtornos mentais ao longo da vida foi 36% para profissionais de saúde e 44,7% para a população geral, sendo os mais frequentes transtornos depressivos e ansiedade generalizada. Entre os profissionais de saúde, ser do sexo feminino e mais jovem foi associado à maior distresse psicológico. Para a população geral foram preditores de distresse a classe econômica e um domicílio com mais pessoas. Foram significativamente associados ao GSI sintomas de Covid-19, sentir-se menos produtivo no trabalho, medo de transmitir o vírus para a família, medo de dificuldades financeiras e sentir que os relacionamentos em casa pioraram. A prevalência de transtornos mentais atinge parte relevante da população brasileira. Fatores sociodemográficos, aspectos familiares e instabilidade financeira devem ser considerados no entendimento do distresse psicológico durante a pandemia.(AU)

BACKGROUND: The burden of mental disorders is likely to increase during the Covid-19 pandemic. Knowing the rate of psychological distress and mental disorders, its severity, and factors associated with psychological distress is strategical. METHOD: We analyzed online cross-sectional data from 164,881 health professionals and from 5,635 participants from the general population in Brazil. The Global Severity Index (GSI) from the Brief Symptom Inventory, self-reported diagnosis of mental disorders, sociodemographic characteristics, and factors related to Covid-19, such as physical health status, diagnosis and contact history, perceptions and concerns, and precautionary measures were compared between samples. Multiple regression analysis was used to investigate factors related to GSI scores. RESULTS: Psychological distress was high or very high in 13.4% of health professionals and in 31.4% of the general population. Health professionals reported a lower rate of current or previous history of mental disorders (36%) than participants from the general population (44.7%). Age (younger) and gender (female) predicted higher psychological distress for health professionals and economic class (lower) and household size (more members) for the general population. People with higher GSI scores reported to have experienced more physical symptoms associated with Covid-19, feeling less productive at work, being afraid of transmitting the coronavirus to the family, fear of financial difficulties, and feeling that home relations were worse during the pandemic outbreak. CONCLUSIONS: Psychological distress at the first wave of Covid-19 was associated with sociodemographic features and an anxious perception of physical symptoms, virus transmission to loved ones, disruption of family relations, and financial situation.(AU)

INTRODUCCIÓN: Es probable que la carga de los trastornos mentales aumente durante la pandemia de Covid-19. Conocer la tasa de malestar psicológico y de los trastornos mentales, su gravedad y los factores asociados al malestar psicológico es estratégico. MÉTODO: Se analizaron datos transversales en línea de 164.881 profesionales de la salud y 5.635 participantes de la población general de Brasil. Se compararon entre las muestras el Índice de Gravedad Global (GSI) del Inventario Breve de Síntomas, el diagnóstico auto declarado de trastornos mentales, las características sociodemográficas y los factores relacionados con la Covid-19. Se utilizó un análisis de regresión múltiple para investigar los factores relacionados con las puntuaciones del GSI. RESULTADOS: El malestar psicológico era alto o muy alto en 13,4% de los profesionales de la salud y en 31,4% de la población general. Los profesionales de la salud declararon tasa de 36% de trastornos mentales y la población general de 44,7%. La edad (más joven) y el sexo (femenino) predijeron un mayor malestar psicológico para los profesionales de la salud y la clase económica (más baja) y el tamaño de la familia (más miembros) para la población general. Las personas con puntuaciones más altas en el GSI declararon haber experimentado más síntomas físicos asociados a la Covid-19, sentirse menos productivos en el trabajo, tener miedo de transmitir el coronavirus a la familia, temer dificultades económicas y sentir que las relaciones domésticas empeoraron. CONCLUSIONES: La angustia psicológica se asoció a las características sociodemográficas y a la percepción ansiosa de los síntomas físicos, la transmisión del virus a los seres queridos, la perturbación de las relaciones familiares y la situación económica.(AU)

Postoperative delirium in the elderly.

BACKGROUND AND OBJECTIVES: Postoperative delirium is a common complication in the elderly whose pathophysiology is not well known. It seems to be related to central cholinergic activity. A literature review was undertaken to describe the etiology, diagnosis, prophylactic strategies, and treatment of postoperative delirium. CONTENTS: Probable etiologies, diagnosis, prophylaxis, and treatment of postoperative delirium in the elderly were described. CONCLUSIONS: The incidence of postoperative delirium is higher in the elderly, and prophylactic measures should be taken to reduce the mortality associated with this complication.

Long-term results with azathioprine therapy in patients with corticosteroid-dependent Crohn's disease: open-label prospective study.

BACKGROUND: A substantial number of patients with Crohn's disease (CD) become dependent on steroids after induction therapy. Treatment with azathioprine (AZA) may be beneficial in such patients. The present open-label study evaluated the long-term safety and efficacy of AZA in steroid-dependent CD patients. METHODS: Adult patients with steroid-dependent CD were enrolled for AZA therapy over a 7-year period. The average dose of AZA was 2.0-3.0 mg/kg per day, adjusted according to clinical response and occurrence of adverse effects. Steroid therapy was tapered off according to a predefined schedule. Long-term outcome and adverse reactions were evaluated. RESULTS: Sixty-nine patients were prospectively included. Steroid-free remission was achieved in 68-81% of patients, partial response in 14.5-27.3% and failure to respond to AZA in 4-15.9% over the initial 48 months. However, the rate of wean from steroid therapy decreased to 53-60% while the rate of failure increased from 6.7% to 17.6% after this period. A breakthrough of symptoms during continuous AZA therapy was common, particularly after 48 months on AZA. The mean leukocyte count at the end of 12 months of therapy was significantly lower in patients who achieved complete response on AZA than in the non-responders (5197 +/- 1250 cells/mm(3) vs 8340 +/- 1310 cells/mm(3), respectively; P < 0.01). Azathioprine was relatively well-tolerated and the incidence of serious adverse effects was small. CONCLUSIONS: Azathioprine was relatively safe and moderately effective for long-term maintenance of steroid-free clinical remission in corticosteroid-dependent CD patients. Patients were more successfully weaned from prednisone treatment, and clinical remission was more often maintained during the first 48 months of AZA therapy. A significant decrease in the white blood cell count at the end of 12 months on AZA was the single factor associated with weaning from steroid dependence.